9/22 Josie AMPS 160 AT +4 170 PMPS 293 (dose change?????)

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Re: 9/22 Josie AMPS 160 AT (HELP )

Can you be there to test Josie throughout this cycle? Have you had a chance to look over the "shoot low go slow" protocol?
 
Re: 9/22 Josie AMPS 160 AT (HELP )

It is a weekday, so no. I can stay home for an extra hour or maybe two, but then wont be home again til + 8
 
Re: 9/22 Josie AMPS 160 AT (HELP )

If you're not going to be there, if I were me, I'd test in 30 min to see if she was rising, Then look at the "shooting low numbers" sticky. It will help you make a decision. Given the numbers on Josie's SS- I would NOT consider you "data ready".
 
Re: 9/22 Josie AMPS 160 AT (HELP )

Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?

A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin. Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value. Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise. In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine. Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

Keep in mind that these are general guidelines, and they should be personalized to your own cat's reactions to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then your experience should be your guide.
Click to expand...


Here is the bit that applies here- remember that you are using an AT meter and these numbers are for human meters- so adjust you're 30 points...
 
Re: 9/22 Josie AMPS 160 AT (HELP )

"you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value. "

i cant wait a few hours, but i can wait about 90 minutes, but then will have ti leave.
what does giving a token dose do? like 1 unit? do you then give a normal dose at night assuming the numbers are safe?
 
Re: 9/22 Josie AMPS 160 AT (HELP )

I would not go with no shot. I would give a token dose of 1U or so. It just depends on what you are comfortable with.

Have you fed Josie since the 160?
 
Re: 9/22 Josie AMPS 160 AT (HELP )

For future reference: When you are making a decision on whether to shoot, you need to withhold food and retest to see if she is on her way up or down. Once she has eaten, you will get a food induced number. Since she has already eaten, I would give her a token dose if anything at all. You don't have enough data to shoot a full dose.




Shooting low numbers: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147
 
Re: 9/22 Josie AMPS 160 AT (HELP )

A token dose is usually 10 - 25% of the dose. Since you are at 3U, that would be about .75U or 1U.

Retest when you get a chance and post where she is at so we know how she is doing.
 
Re: 9/22 Josie AMPS 160 AT (HELP )

i agree with the others - i think you're probably ok giving a 1.0-1.5 (token usual) dose. when you get more testing information and you know better how josie responds to insulin and feel better about giving the shot. eventually you have to be able to shoot lower numbers, but only when you're ready - and perhaps in your case on a weekend when she can be watched.

her spreadsheet is looking pretty good. the amps is often the last number to come down - you're going to want to get more mid-cycle tests in (maybe right before you go to bed) because it looks like her insulin needs might be reducing. how did she start at 3units? was she on another insulin or getting insulin before the ss started?

if you shoot then make sure you leave some food out for her if she needs it.

you can also skip the shot if you'd feel better.
 
Re: 9/22 Josie AMPS 160 AT (HELP )

julie1220 said:
her spreadsheet is looking pretty good. the amps is often the last number to come down - you're going to want to get more mid-cycle tests in (maybe right before you go to bed) because it looks like her insulin needs might be reducing. how did she start at 3units? was she on another insulin or getting insulin before the ss started?
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her shot is at 11 pm, so i am dead tired by then and want to go to bed. if i wake up in the middle of the night to go to the bathroom i'll try to remember to find her and test her, but i cant be staying up or waking up at all hours to test her. I dont have the time money or energy for that.

The vet started her on 3 units right at diagnoses, than 2 or maybe 3 weeks later when they did thier in house curve they raised it to 4.
 
Re: 9/22 Josie AMPS 160 AT (HELP )

I suspect that the vet has her on too high of a dose. They usually start at 1U and then work their way up. Jumping from 3U to 4U is pretty drastic and is a lot of insulin. Were they doing the curve at the vet? Tarragon's BG goes up by 100 - 150 when we take him to the vet due to stress, so they were giving him way too much insulin before we started home testing since they were basing it off of the curve at the office. Home testing is really the key.

You could put her on 1U and start from the beginning yourself, especially if you are not able to test regularly right now. I know it is hard when you work and have this going on as well. We do our tests at 5:30, so I am able to get +2 & +4 every night. You will just need to find a schedule that works for you. I do a full curve (every 2 hours for 12 hours) one weekend day a week.

Also, I know that yesterday you all were talking about meters and strips. I just switched from the Contour to the Arkay meter, which uses the same strips as the Walmart Relion. The strips were killing me in cost. These are much much cheaper. You might look at American Diabetic Wholesale online. I got the meter and 200 strips for $39.95.

Good luck and ask a lot of questions. We are all here to help!
 
Re: 9/22 Josie AMPS 160 AT (HELP )

i understand! getting up at night sucks. any chance you could move her shot time earlier so it's easier to get later tests?

just in looking at her spreadsheet, i see the consecutive pmps numbers of 235-215-211-148 this week and if you had shot the entire 3units today, i would guess it would've been lower than 148 at pmps. in order to reduce her dose she needs to go below 50, but going below 50 then requires you to give her some high carb food to pull her up so she surfs above 50.

i'm just flagging it for you - i'm not an expert but it looks to me like she's going to need a dose reduction before long. somehow you have to be able to catch those midcycle numbers so you see the number but keep her safe.

the path to going OTJ looks a lot like the path you're on - hold a dose and numbers decrease overall, then drop below 50. then you reduce the dose and hold it for a few days, the numbers decrease overall, then drop below 50. it repeats until she doesn't need insulin. that's the safest way that gives the best outcome for a kitty staying off of insulin.

again, i'm not an expert, but if your goal is remission it looks like she might cooperate, but to make it happen it's going to take the watchfulness and ability to respond on your part. just want you to be aware of all of that.

if you shot less than the full amount this morning, go back up to the regular 3.0 units tonight and proceed on.
 
Re: 9/22 Josie AMPS 160 AT (HELP )

ADW charges 30$ to ship to Canada, negating any discount.
When she was diagnosed she already had hindleg neuropathy, maybe that is why they started her high?
I cant change her time, there is only one time that works for me to be able to do both am and pm every day of the week. and that is unfortunately 11 and 11. i am alone, no one else can help me with it, so i had to try to fit it into my schedual where i could. as it is i am missing out on a million things in order to make sure i am home with her. i cant/wont give up more. there is a point at which ruining your life for a cats health becomes too much, and i am approaching it.
I love josie, but i am going insane.
 
Re: 9/22 Josie AMPS 160 AT (HELP )

Ok, I shot 1.5 units this morning and will try to bus home and get a test at + 4 or +5 if i can.
Thanks everyone.
 
Re: 9/22 Josie AMPS 160 AT (HELP )

Understandable. It is VERY overwhelming at first, but it will be ok. Really it will. I didn't think I could do it and have. So, we just need to come up with a plan for you that will work with your schedule. That is one of the reasons I suggested going to 1U and starting from scratch. You don't want to give too much insulin and have Josie go hypo on you while you are gone. Maybe if you go to 1U and work your way up it will be better.

Can you test one weekend day a week every 2 hours or so, or at least get some extra tests in?

Do you leave the house right after AM shot and get back right before PM? Is there any time in there that you are home and not asleep?

We have a couple of single "parents" out there who are working 10+ hours a day and are in the same boat you are. Mike & Buddy is a good example. You might look at what he does and see how he has made it work. Also, Tigger & Brent are single beans.

Hang in there. We will help you through this.
 
Re: 9/22 Josie AMPS 160 AT (HELP )

Hi guys .. I know this is all overwhelming and a lot to take in .. you are doing great and this mornings numbers are looking awesome!
 
Re: 9/22 Josie AMPS 160 AT +4 170 (dose change?)

It is +8 and she is at 197.

I am going to start doing the "start low go slow" thing. Should I lower her dose to 2?
 
Re: 9/22 Josie AMPS 160 AT +4 170 (dose change?)

When doing the slow and low routine, do the other guidlines still count too? Like, below a certain number, dont shoot, or give less or what not?
 
Re: 9/22 Josie AMPS 160 AT +4 170 (dose change?)

I'm not familiar with the protocol. However, after reading it, that seems like a good approach for you since you aren't able to get mid cycle tests consistently. Whether you start at 1U or 2U I'm not sure. Is Josie on dry or canned? I think the other rules apply with all protocols. Hopefully someone can come along and tell you for sure.
 
Re: 9/22 Josie AMPS 160 AT +4 170 PMPS 293 (dose change????

Ok, I am going to give her 2.5. That is lower than her normal dose. Bring her down slowly. I have no idea if it even makes a difference
 
Re: 9/22 Josie AMPS 160 AT +4 170 PMPS 293 (dose change????

I think 2U would be a good starting point. It does make a difference. I know you are overwhelmed right now, but it will be ok. Start at 2U and keep doing your testing.
 
Re: 9/22 Josie AMPS 160 AT +4 170 PMPS 293 (dose change????

The thing that is difficult is your dose is based on nadir, or lowest point in the cycle. This usually occurs at +6 or +8. Since you are only testing right before the shot, we don't know how low Josie is actually going at nadir. That is why getting a full curve this weekend would really help and a +2, etc anytime you can get it is essential. 2U would be a safe dose to start out at for now. Leave her at that dose for 6-10 shots and then see where she is at. Her insulin "shed" needs to fill, so it will take a few days for her numbers to come down.
 
Re: 9/22 Josie AMPS 160 AT +4 170 PMPS 293 (dose change????

I cant do a curve this weekend. I have a wedding out of town saturday and am going to my families house for most of the day sunday.
 
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