8/11 Charlie DoseIncrease PMPS418 +2 299+4 263+6 275+10 401

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charliesmom

charliesmom

Member Since 2012
yesterday

Shoot or wait 15 minutes, retest to be sure her numbers are going up, and then shoot?

7am: BG at 90
Retested at 7:15: BG at 90
Retested at 7:30: BG at 92

At this moment, we didn't increase to .75 since we are still not 100% comfortable with that but we did shoot a low number.
I hope this was a good decision but I must admit I don't know how this day is going to go now. Hope some people are around on the board just in case of emergency. I left out a generous amount of food and am monitoring Charlie closely. Will retest at +1 in 30 minutes.

Charlie will be at the vet again on Monday morning for a urine culture and sensitivity test. As she still shows leukocytes in her urine, she'll probably be back on antibiotics again this week too. Don't want to introduce too many variables all at once so for now, I decided to test "shooting at a lower number than what I am normally comfortable with" since it is Saturday, we are both home, and hopefully we can learn from this without taking too much risk.

Marjorie: To answer your question from yesterday, Charlie has not been vomiting and has not had diarrhea for awhile. Yesterday she was cleaning herself and even played with a little catnip toy for awhile.
 
Re: 8/11 Charlie +12 90 shoot or stall?

I think you might want to edit your title and add a question mark or put Question in subject line.
at this moment, it's just you and me.
Hopefully in a few minutes, someone will be checking and I want it to catch their eye.....
 
Re: 8/11 Charlie +12 90 shoot or stall?

Thanks Rhiannon. I retested a 3rd time at 7:30 and it was 92. Decided that since 2 people on the board now have encouraged us to consider increasing the dose, we should at LEAST shoot this morning and monitor closely to see what happens. We have never shot this low before so I'm a bit nervous, but I do have my sheet out on "handling low numbers" and hopefully people will be on the board soon in case of the need for advice. At this moment, we did not increase Charlie's dose. Just shot her current dose of .5 thirty minutes late (after confirming her numbers were increasing in some way).
 
Re: 8/11 Charlie +12 90 shoot or stall?

Did you shoot? Dont worry as long you've all the "things" ready; testing strips, HC or karo to bring up the bg. From you previous, noticed that Charlie is in better condition than before which is good. He's willing to eat?
90 is not too low , but if you are worried, test in an hr & post here.. Remember to update your topic head. You'll be fine.
 
Re: 8/11 Charlie AMPS 92. SHOT LOW. Hope this wasn't a mist

Thanks. Thank God there are at least a few people awake and in this time zone at the moment. :smile:
I have pre-filled a syringe with maple syrup and also have 1 can of Hill's Prescription A/D Critical Care wet food on hand from the last time we were at the ER (this kind can be fed through a syringe as well).

Confirmed online that this has 15% carbs so I guess that is what is considered HC wet food, right?

Charlie has in general been eating normally this past week. In addition, at each BG, she's getting tuna so I think in the food department, she's OK for the moment.
 
Re: 8/11 Charlie AMPS 92. SHOT LOW. Hope this wasn't a mist

The first time usually the hardest. You'll be fine with everything ready , just remember dont panic. Not all kitties will have hypo symptom when going low. When you are testing, there is no risk. If charlie is a bit low ; near the 50's just fed him a tsp of his normal LC to let him surf. Remember not to overdo with the maple syrup or HC. Seldom we need syrup or Karo. We want them to surf the green but not going under 50. Dont overfeed because we will need kitty to eat when they are low.
 
Re: 8/11 Charlie AMPS 92 +1 140. SHOT LOW. mistake?

Jill, good morning - My husband switched off the alarm this morning, otherwise I would have been here at 7... Can't be helped now.

Are you ok?Any BG update? Saw the (+1) on her SS - anything after that?
Jane

P.S. Thanks for being here Helen!
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 SHOT LOW. mistake?

137 at +2!

Good morning Jane. So far so good.

Really wanted to get a +10 last night. My alarm didn't go off either. Or I slept right through it? Darn.
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 SHOT LOW.

(((Jill))) Sorry about your alarm! Annoying.

I'm so sorry I wasn't around this morning and couldn't weigh in when you were at shot-time. Let's see how this cycle goes. In any case, it's good that you didn't skip the shot, and everything else is past so can't be helped. I like that (+2), but looking at your SS (say, the 21st and 27th of July, for instance), Charlie has snuck in some drops at mid-cycle, so I'd feel happier of you could keep a close eye on this one.

When was she last fed?

Knowing my testing-OCD, I would probably get a (+3) to see if she's planning something, despite the nice blue surf she has going so far. How do you feel about that? Are you able to watch this whole cycle?

Jane
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 SHOT LOW.

Hi Jane,

Thanks for the advice. I will get a +3 right now (was planning to do so anyway as we have an appointment in a few hours and are thus potentially unable to watch this whole cycle). This is TBD of course, because if during the next 2 tests, Charlie's numbers go down further, we may have to cancel our appointment and stick around.

Sort of playing it by ear as this is the first time I have shot low so I'm not exactly sure what to do. I will test at +3 and +4 and re-evaluate. Can you help me make the call based on these tests?

Charlie didn't eat much of her food this morning, but she did eat a LOT of tuna at each test time, so in a way, she still got a full meal in.
At the moment, she's hiding behind the couch, but that could also be because normally she sleeps in the mornings and I have been disturbing her every hour. :lol: Know how annoying it is when somebody wakes me every hour, so who knows? Maybe she's just trying to get some peace. I will disturb that peace now for +3! Sorry Charlie...
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 SHOT LOW.

+3 just failed miserably. Charlie bit me and then hissed like a tiger. We will wait a few minutes until she calms down and try again. Maybe even wait until +3.5? What do you think?

Just give her 5 minutes or give her a bit more time to calm down?
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 SHOT LOW.

(((Jill))) and (((Charlie)))

Sorry you were bitten and hissed at! I would give her that half an hour to settle down. A (+3.5) will be fine. For the record, even a (+4) wouild most likely be alright given her lovely surf and her not having gone dangrously low at (+3), at least as far as we can see. That 38 she had on the 21st of July was at (+4). I'm just being extremely cautious and would get that (+3.5) anyway, if you can.

Jane

ETA: It's a good thing you've got a decent amount of BG readings - being data-ready is what will help assess this cycle and keep Charlie safe (and you comfortable). It's not as though you haven't shot below 150 before. You have - (26th July, 29th July, 2nd August, even if those AMPS were only *just* sub-150). Keep breathing, k? Charlie will pick up on your stress, and it won't help you if she mirrors it. Grab a cup of tea, maybe. You're going to be fine. Charlie's going to be fine.
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 SHOT LOW.

While we wait, let's review, k?

You made a good call, I think, when you decided to stall (and not feed) to see if you got a rising number.

Alas, luck would have it that you did *not* see a rise. What that means is that you shot into what looked like a surf. (A +11 before AMPS would have given you an even better idea of how Charlie got to that 90s number at pre-shot. You can see where that becomes relevant, right?)

What you *could* have done is stall a bit longer to see the moment you got a rise, and *then* shoot. (See the Sticky: 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. Perhaps the most important guideline in shooting low is that any time you shoot your lowest ever number, you should get a +1 and +2 to give you an idea of how the cycle will go. If the +1 is not higher than PS, or if +2 is much lower than PS, that means “pay attention” over the next few hours. Those tests will also help you become even more data ready for the next time you are presented with a low preshot reading.")

You got the (+1) and (+2), which is good, since that AMPS this morning was the lowest you've shot. Those follow-up tests showed you a nice rise into the blue. Now we're waiting to see what Charlie does when onset kicks in, and then we'll make the next decision.

With me? :mrgreen:
Jane
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 +3.5 176

Clear. I had just read that text this morning and that's what encouraged me to do the +1 and +2 while nobody was on the board.
What worried me though is that it is impossible to do blood tests with Charlie without giving her tuna. So in a way, it's not that we're testing her on no food. She eats the tuna and that is what enables us to calm her down enough to test. We actually test while she eats the little bit of tuna each time. This morning at 7, 7:15, and 7:30, she got tuna each time. I don't know how much but it was a bit as it was the only way to get her to stay still for me. So I was a bit concerned that maybe the food had an influence on her numbers. I only realized this after I shot into the 92 this morning. When I thought it over, I realized:
- I didn't have a +10 or +11, so I didn't know how she got to the 90 at 7am. I wondered if maybe she was lower before that and I wish I had caught her +10 or +11 to know.
- Then she ate tuna at 7, 7:15, and 7:30, so even though the number increased to 92 at 7:30 and I shot... I reflected afterwards and thought "OOPS! Maybe I should have stalled longer.
- What made me shoot without stalling longer was the encouragement from Sienne and Marjorie to increase Charlie's dose to .75
We still haven't done that yet, but this morning I thought, well, if I shoot low and test it out, I will have more data to really know if the .5 units are still having an effect, or if she needs more insulin.

I'm not sure now if this was actually logical or not as shooting low and increasing/decreasing are probably really 2 entirely different topics and therefore unrelated. In any case, I wanted to keep progressing forward in some way this morning. Since I was on the fence about increasing, I thought I could at least take a step towards testing low and gathering data.

At +3.5 charlie was 176. She's a bit annoyed so I don't know if her numbers are at all inflated by that.
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 +3.5 176

Regarding the tuna - I don't think that would create much of a spike, since it's essentially protein in water with a bit of salt, but I've never tested after feeding tuna with the specific intent of watching how much the food affects the following BG so I can't say for certain. The stress, yes, that may also be playing into the numbers here, but again, other than keeping it in mind (which you are), I wouldn't get too focused on that right now.

Regarding the stalling-for-less-time (topic of shooting low) because you were advised to increase Charlie's dose (topic of dosage) - Remember that the dose you shot this morning won't factor into how this cycle will go that much. It will have more of an effect on the *next* cycle(s) because of the cumulative nature of Lantus and how it works - the shed needs that bit of time to begin to react to dosing changes. I see the *psychological* hesitation about doing the increase, but just based on the Lantus-Theory, it wouldn't have made that much of a difference on THIS cycle. (It *may* have already affected the upcoming PM-cycle. This way, we'll wait and see - if YOU are ready for the increase by tonight's PMPS - since we think Charlie already is - we may have an interesting AM-ride tomorrow. Or PM tomorrow. It's a watch-and-wait sort of thing.

The concern is that Charlie might get too used to hanging out in the higher numbers and her susceptibility to the effects of insulin may change. Marje mentioned insulin resistance yesterday. We want to avoid Charlie's body growing accustomed to the higher numbers to such an extent that she won't respond to the Lantus the way we want her to.

Does that make sense to you?
Jane
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 +3.5 176

Keep on that surfboard Charlie and note to the Bean be sure to clean that bite wound good cat bites can really get inflamed I am a vet tech and the few times I did not clean a cat bite right away it really got infected on me hope Charlie is settling down some for you
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 +3.5 176

Thanks Lisa and Do Lou (such a sweet little kitty, I tell you)! The bite ended up being really more of a scratch on my hand. I put some neosporin antibiotic ointment on it so it should be OK. Thanks for thinking of me.

Does Do Lou like to play in water, by the way? My friend has a cat like that and he jumps in the shower with her because he LOVES water. Abysinnians are really so active compared to snuggly old, sleepy Charlie. They're fun to watch. Hope Dou Lou is still having that energy, even after the diabetes.
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 +3.5 176

Makes sense, Jane. I understand the logic and will consider. Maybe this evening wouldn't be the worst time to test it out as then I may have more data after tomorrow's cycle to talk to the vet about? I guess I'm just worried that if Charlie is getting .5 at AMPS (as she did this morning), isn't that an indicator that the .5 is doing something? And how does one really know when to increase further? Only by testing it, and if she then has a bad reaction (hypo) we go back down again? I guess this is a lot of trial and error, and I do trust that you guys are experienced and have a much better handle on what to do than we do.

I just read multiple times from everyone that an infection (which Charlie still has), can also drive numbers up. So until that is gone, it could be that an increase could be premature. Isn't this possible?

We are back at the vet on Monday for the urine culture and sensitivity test. Guess this will tell us more either way. Maybe not about the dose increase (we may make that call at PMPS), but I do not feel 100% clear on this in my own mind. That psychological hesitation statement is really spot on.
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 +3.5 176

charliesmom said:
Thanks Lisa and Do Lou (such a sweet little kitty, I tell you)! The bite ended up being really more of a scratch on my hand. I put some neosporin antibiotic ointment on it so it should be OK. Thanks for thinking of me.

Does Do Lou like to play in water, by the way? My friend has a cat like that and he jumps in the shower with her because he LOVES water. Abysinnians are really so active compared to snuggly old, sleepy Charlie. They're fun to watch. Hope Dou Lou is still having that energy, even after the diabetes.
Click to expand...

Yes abys can be so active and love water as for Do Lou he used to wait for me to shower every days so he could play with the drips but after he went blind he lost interest as for activity he honestly does not do much I often take short videos of him having play moments since they are so precious to me the loss of his sight really slowed him down but he is doing really super overall for all his health concerns if you go to his profile he has several play you tubes on it and here is one of a aby kitten we sold who now lives in Houston she loved water more then any aby I have seen I am told by her owners she often showers with the husband so cute her name is Sugar Baby first video was her finding the sink for first time and she sat there for hours next is her in the bath she just jumped right in I had never had a aby just jump in like she did and BB the fawn watching her I am sure is thinking she is crazy
[youtube]XbhL1GUKNnI[/youtube]
[youtube]B7R83o7-d_k[/youtube]
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 +3.5 176

charliesmom said:
Makes sense, Jane. I understand the logic and will consider. Maybe this evening wouldn't be the worst time to test it out as then I may know after tomorrow's cycle to talk to the vet about? I guess I'm just worried that if Charlie is getting .5 at AMPS (as she did this morning), isn't that an indicator that the .5 is doing something? And how does one really know when to increase further? Only by testing it, and if she then has a bad reaction (hypo) we go back down again? I guess this is a lot of trial and error, and I do trust that you guys are experienced and have a much better handle on what to do than we do. I just read multiple times from everyone that an infection (which Charlie still has), can also drive numbers up. So until that is gone, it could be that an increase could be premature. Isn't this possible? We are back at the vet on Monday for the urine culture and sensitivity test. Guess this will tell us more either way. Maybe not about the dose increase (we may make that call at PMPS), but I do not feel 100% clear on this in my own mind. That psychological hesitation statement is really spot on.
Click to expand...

The way I see it from looking at Charlie's SS and going back over your previous few condos, the main issue is not that the current dose of 0.5u isn't doing *anything* but that it isn't doing *enough*. Were the 0.5u a zero-action dose for Charlie, she would most likely not have shown the green numbers that she *has* thrown in. But - and this is what, in this case (and despite the guidelines, reasons for decisions can and do vary according to individual situations, cats, and caregivers) prompts the dose increase to 0.75u, the action Charlie *is* getting from the current dose is NOT keeping her out of the unhealthy pinks and reds for enough of the time (even factoring in bounces and bounce-clearing BGs). IF Charlie then shows a BG below 50 after an increase to 0.75u, the dose will be re-assessed.

You are right in that an infection can and does influence BGs. BUT, again, the main issue that's being focused on right now is the amount of time Charlie is spending in high numbers. Spending most of her time there may, as Marje underlined, result in Charlie becoming less sensitive or even resistant to insulin. Treating her and bringing about healthy numbers than become even more difficult. So while keeping the infection in mind is the right thing to do, delaying an increase to address the currently even more pressing matter (of her higgh numbers and their possible longer-term effects) is not the safest choice at this point in Charlie's treatment, especially when and while you *can* monitor her closely to make sure she doesn't drop too low (if that's what she would or will do on 0.75u).

The urine c/s test will hopefully help by adding another diagnostic tool to the process of assessing Charlie's FD-status and making future treatment choices. It will hopefully *also* alleviate the worry you have on that score. You're right that this process of finding the right dose and ensuring or attempting progress can and often does take a trial-and-error shape, and the emotional and psychological toll this takes is certainly a factor to remember. But because treating and dealing with FD just IS such a complex matter, where, you are right again, so many things reflect on and affect others in terms of theory, guidelines, choices and so on, it sometimes comes down to making the most pressing issue the priority, and watching all the others as one makes a choice based on that pressing issue.

Sorry about rambling on! Does that help though?

Where are you in terms of testing now - at about (+4.5)? Have you got another BG reading yet?
 
8/11 Charlie AMPS 92 +1 140 +2 137 +3.5 176 +5 245

+5 was 245.

We will likely increase to .75 tonight. I understand the logic and I guess it's better to keep moving forward. Can someone post the photo of the syringe at .75 so we can see it again? Saw this somewhere but can't recall where on the board this was.

We will take a break for the afternoon and let Charlie get some rest. Will post an update after testing again later in the day. Seems to be rising consistently and safe to leave for a bit. Agree?
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 +3.5 176 +5 245

I'm sure you'll still have others weigh in, but as for IMHO, I would go ahead with the increase tonight, barring any incident precluding this. That (+5) justifies giving Charlie a bit of a break, I would say. You *can* always get another mid-cycle BG to be sure, if you want. Otherwise, I'd encourage you to get a (+10) and (+11). I'd get them both mainly to put YOU at ease with whatever dosing decision is finally made tonight. Dear Mr. Bacon told us, knowledge is power - and dear Jojo told us, know thy cat :mrgreen:

Here are two links for fine dose gradations: Pet Diabetes Fine Doses and Pet A Bit Syringe Fine Gradations though neither of them depict a 0.75u, so I will take a photo and post it for you in a minute, k?

Good job today.
Jane
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 +3.5 176 +5 245

Jill, here are 2 photos. The first is of 0.75u in a BD U-100, 0.3ml syringe.
From the top, the boxes and lines explained:
RED Box: Outlines the 0.5-Unit line marking.
RED Line: Shows the BOTTOM of the 0.5-Unit line marking.
GREEN Line: Shows where the TOP of your PLUNGER should be for a 0.75-Unit dose (half-way between the RED and the BLUE lines).
BLUE Line: Shows the TOP of the 1.0-Unit line marking.
BLUE Box: Outlines the 1.0-Unit line marking.

313074_10100308301239253_1591679205_n.jpg



The second photo is of 0.25u and is taken from the "Lantus & Levemir: New to the Group? Please Read"-Sticky. (I posted it as well because it shows the same thing, BUT SHIFTED UPWARDS in the syringe by half a unit of insulin.

025unit-1.jpg


Hope these help you. I didn't find any actual picture of the 0.75u, that's why I'm subjecting you to my own photo :mrgreen: (The liquid I used is not insulin, it's juice, to help a bit with the visual, since it's slightly coloured.)

Edited to Add: :lol: Apparently I simply didn't see the 0.75u picture *right next to* the 0.25u picture. Obviously need more coffee :mrgreen:
5e86c3d4.jpg
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 +3.5 176 +5 245

Jane provided a wealth of information. There's only a point or two I would add. Infection or inflammation can raise BG numbers. And you're correct, as an antibiotic works and the infection is clearing, numbers can drop. I'm less concerned about dropping numbers than I am with higher numbers associated with an infection. Dropping numbers can be easily managed with food and by reducing the dose.

The risk of not increasing the dose if an infection is suspected involves additional complications. Whenever an infection is present and if insulin dose is too low, the potential for ketones developing is increased. Ketones is not a place where you want to go.

If you follow the guidelines of the Tight Regulation protocol, you will have a means for making decisions regarding dose. The strategy behind the protocol is to aggressively bring numbers down into a healthy range in a safe manner. The more time a cat spends in high numbers, the greater the possibility of diabetes-related organ damage. The more time a cat spends in a normal BG range, the greater the possibility for remission.
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 +3.5 176 +5 245

Sienne and Gabby said:
Jane provided a wealth of information. There's only a point or two I would add. Infection or inflammation can raise BG numbers. And you're correct, as an antibiotic works and the infection is clearing, numbers can drop. I'm less concerned about dropping numbers than I am with higher numbers associated with an infection. Dropping numbers can be easily managed with food and by reducing the dose. The risk of not increasing the dose if an infection is suspected involves additional complications. Whenever an infection is present and if insulin dose is too low, the potential for ketones developing is increased. Ketones is not a place where you want to go. If you follow the guidelines of the Tight Regulation protocol, you will have a means for making decisions regarding dose. The strategy behind the protocol is to aggressively bring numbers down into a healthy range in a safe manner. The more time a cat spends in high numbers, the greater the possibility of diabetes-related organ damage. The more time a cat spends in a normal BG range, the greater the possibility for remission.
Click to expand...

Darn, you're right Sienne, I didn't emphasize that infection/inflammation can *raise* BGs - and I just plain *forgot* to underline the ketone-threat and possibility of organ damage, which increases with prolonged raised numbers! Thanks for this! I take it you agree with my advice to Jill, to increase to 0.75u (barring further incident) as Marje already suggested yesterday?
Jane
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 +3.5 176 +5 245

I am keeping an eye on your condo and rooting for you! I am a newbie so I totally understand reluctance to shoot low, the first fear we learn about fd is avoid hypo. Later we learn the hazards with hyper, but that first lesson about avoid hypo seems to dominate thinking for a long time. I can't give dosing advice, just offer you morale support and understanding how hard it is sometimes to trust the protocol and make the shot.
Leslie
 
Re: 8/11 Charlie AMPS 92 +1 140 +2 137 +3.5 176 +5 245

Yes, Jane, I agree. I think both Marje and I suggested an increase but I believe we made the suggestion on different days.
 
8/11 Charlie PMPS 418 Increased Dose to .75

Thank you for your encouragement everyone. As much as it scares the heck out of me to increase further, we are going to give it a try. We will monitor this sweet girl closely and keep posting updates if we need advice and help. Thanks, as always, for helping us. Jill

Can someone please give some advice on which times are important to test tonight? We do not want to test every hour so want to be sure we catch the important ones.
 

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Re: 8/11 Charlie PMPS 418 Increased Dose to .75

Great picture! What a beautiful kitty. :-D I would get a +2 and see where she is then.
Liz
 
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