About to open new bottle, need advice

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Helena and Gandalf

Helena and Gandalf

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Hi!
Gandalf is currently back to normal after his sudden illnes with diarrhea, vomit and high white bloodcell count a week and a half ago. We are currently awaiting the result of his parasite-test to see if he has any common or unusual parasites. We have just discovered his brother probably have tapeworms (visible signs) and will treat him. But we decided to wait for the vets recommendations for Gandalf before giving him anything, we don't want to treat if it turns out to be unnecessary.

As you can see in Gandalf's SS he has a very flat curve and his values does not seem to change at all even when we increase the dose. I posted a thread about two weeks ago, before he got ill, asking for advice (see here http://www.felinediabetes.com/FDMB/...s-to-prozinc-need-a-plan.171700/#post-1884383) and mentioning we had accidentally left the bottle of insulin on the counter. We did unfortunately not note the dates when this happened but it was probably somwhere around January 14-18. :facepalm:

As we want to be sure his odd numbers are not due to inactive insulin we thought we might try a new bottle now. IF it is inactive insulin, we are worried the 2.50u dose might be too high. Should we start over at a lower dose when opening this new bottle and work our way up again? I should mention that we have the luxury to be home with him all day tomorrow so we could just give him 2.50 and monitor him closely.

The other option would be to stay with this bottle for the remaining ~30 days and continue raising the dose. It just feels odd he seem to need so much higher doses of Prozinc than he did Lantus (1.25u), but I guess the difference in concentration is fooling us...

Would really appreciate some advice what to do with the new bottle, and also suggestions why his BG numbers are so odd. Thanks! Helena and Gandalf :cat:
 
High-ish and flat suggests either bouncing from a dose that's too high or else a dose that's simply too low. I think it's a case of the dose being too low. I would continue the increases in 0.25u increments every 3 cycles or every 2 days. Most of us prefer to increase a dose in the AM.

I'm always cautious when starting a new vial of insulin. If you're around to test, stay at the current dose. If you're worried, drop the dose down by 0.25 u.
 
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Yep I would probably drop the dose a bit if I wasn't around to test. If you are around, just be sure you're prepared if you have to steer, that's all. :)

Keep us posted!
 
The new bottle made no difference, but the raised dose AM yesterday sure did! We have not seen these numbers for months! :joyful:

The problem now is that we have now idea how to handle this. We lowered back to 2.5u at PM because we really needed to sleep and did not want to risk him dropping to low since we had to feed the curve earlier. We are thinking of holding the 2.5 for 3 cycles and then make a smaller increase using the U100 syringes and the conversion chart. Any other suggestions?
Would also sreally appreciate some tips on how we should handle a low reading, like the 11.8 at PMPS yesterday, lower the dose or not?

This is all really scary because we really really really want those low numbers but it will be tough to get up at night to test and going away during the day if we need to feed the curve. So nice to finally see some low numbers, you could really tell the difference in values just by looking at him playing! :cat:
 
Nice cycle yesterday. The U100 syringes and conversion chart would let you do a 2.6. You can also do a fat 2.5 with your U40 syringes.
 
Lovely green but scary at the same time. What you need is a lot more data in this dose range to see what his responses are. That will help you decide whether you can dose at a lower number, etc. A lot of this is harder when you can't be home to monitor but the U100 syringes with conversion chart will certainly give you more dosing fractions to work with.

If a PS is low:
  1. First you need to know what your "no shot" cut off number is and it will change (lower) as you get more experience.
  2. Try the stall for 20 min/retest technique. If BG has risen to a point above your no shot number, feed and give a very slightly reduced dose (0.2 u less). Repeat in 20 min increments up to 60 min until you get above the no shot number.
  3. If the BG is fairly close to your no shot number but a bit below and you don't have time to stall, give a reduced dose (30% to 50% of regular dose?).
  4. Skip the shot.
There are other variations on these methods but you need more data on how Gandalf is responding first.
 
Greens are scary when they first appear but they're the goal. Managing them is harder though when you have to be out all day. That might mean being more conservative in order to keep Gandalf safe.

Ways to handle a lower PS:
  1. First, decide what your "no shot" number is (NS).
  2. If PS is low, try stalling without feeding for 20 min, retest, and if the BG is high enough, feed and shoot a slightly reduced dose (0.2 u less?). Stall in 20 min increments up to 60 min and repeat the retest after each.
  3. If you don't have time to stall and BG is near NS, give a much reduced dose (30 - 50% of regular?).
  4. Skip shot.
 
Woohoo! Look at those nice greens! They are scary at first, but as Kris says, they're the goal.
 
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