8/26 Sue and Ruben - OTJ question

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Sue and Ruben

Member Since 2010
hi. i have had excellent numbers the last couple of weeks with Ruben. He has been on the Lantus for almost 2 years.
except for a blip up in the numbers (when he went to the vet, stressful) he has maintained double digits and low 100's
i have stopped giving him the AM shot and have been giving only a small dose (.25) in the evening. my question is how long should i expect this to last before he is completely off the insulin? i also have been hesitant to give him anything for the PM shot, as he often is in the low 100's and by 4 hours later, he is back to 70's or so. Any advice overall? PS: there are blocks missing in my spreadsheet ..but the last month of data is in there. I know I could be getting more overnight checks but this is what I have right now. Thanks.
 
We don't typically work a cat's insulin they way you've been doing it. Rather than going to once a day dosing, we lower both doses down to 0.1u and then start an OTJ trial. Right now, with the way Ruben's numbers look, I would not attempt an OTJ trial -- there's too much blue. I tend to think you may have decreased his dose too rapidly from 1.0u. With the SID (once a day) dosing, his pancreas doesn't look happy. You want to provide as much support to his healing pancreas as possible for as long as possible, especially since Ruben in a longer term diabetic.

How about sticking with 0.25u BID. If his numbers are largely green for a week, then reduce to 0.1u. (There are photos of the dose in the "New to the Group" sticky.) If he's green for a week, then the 14 day, OTJ trial countdown starts.
 
Hi, I only reduced to 1X day on the advice of the vet. The reason: i was out of town and my pet sitter was not going to do BG checks. I think this made the most sense as to not be shooting in the dark. Since I have returned, I have been reluctant to shoot at anything under 100. Over 100, i have shot .25 unit. Are you suggesting to shoot under 100? I have looked at the tight protocols but even there, that is not suggested. I could do less than .24 but it is really hard to see that little on the syringe (and i have the ones with the 1/2 unit marking) pls. advise. thanks again
 
It is possible to shoot a drop. What worked for me is compressing the syringe plunger, inserting into the cartridge, and releasing the plunger. That sucked up one nice drop. Give it a try. Make sure one drop comes out when you push the plunger - some syringes don't work well for this. I ended up using some old U40s I had, and they worked much better then the U100s. Since it is a drop, and not an actual measurement, U40 vs U100 doesn't come into play here.

MJ&Donovan
 
Thanks will try the one drop. Question is whether to give a drop under 100? When I have given the .25 dose, sometimes he has dropped in a couple of hours to 60 or less...and I had to feed high carb with karo because he had not even reached nadir. These numbers with such low dozing over the past couple of weeks is the best he has been in 2 years.
Now the question is how to keep him in the green.
 
I don't know how many drops are in 0.25U (other microdosers here might be able to tell you), but it's as close to nothing as you can get. Give it a try when you are around to monitor and then you'll see how he reacts to that dose.
 
sue, you might want to study alex's 2009 spreadsheet. click on the link in my signature and then select the 2009 tab at the top of the page. you'll see i purposely tested waaaaaaaaaaaaaaaaay more often than necessary to illustrate the effect of shooting full doses on low preshot numbers. as a general rule of thumb, we shoot on preshot numbers greater than 50.

obviously, the first few times you want to be around to monitor.


01unit-1.jpg
025unit-1.jpg
 
Hi jill. Thanks for the photos. I had no idea you could shoot as low as 50. My rule of thumb was not to shoot under 100.
What I will do is .25 both amps and pmps and test a lot during the day and before bedtime. Very hard to do so in the middle of the night. I guess I should not panic if hit dies to 40 or 50. I had given him karo and hc in the 70's if he had just had a shot a few hours before.
 
generally, we reserve karo and hc for when kitty drops below 50 depending on the individual cat's sensitivity to carbs and where you're at in the cycle, BUT they can also be used to control dramatic early drops when you know you're not even close to kitty's nadir. using food to manage the curve is a method many of us use on a daily basis.

glad you'll be getting a before bed check. those before bed spot checks will give you a good idea if further testing is necessary.
 
i just tested and at pmps he was at 142 so i gave him .50 units. not even 2 hours later, he was at 93. then 1 hour later (3 hours after the evening shot) he is at 53. that is a huge drop in a short time. that tells me i need to decrease to .25.
i have fed him some high carb and gave a bit of karo. my issue is that every night i am running into the same issue (even with .25) where he drops to very low numbers way before nadir. any other advice. i need to go to sleep and am worried. thanks!!
 
I don't think Jill was suggesting that you shoot 0.5u. You could shoot 0.25u or even 0.1u.

I wouldn't assume that nadir is at +6. Nadir can be at any point in the cycle (e.g., Gabby typically nadirs at +4.) and the nadir can change.
 
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