Beau - 8/21 - reduced dose, how long to hold?

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alicia.1771

alicia.1771

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Previous post regarding decision to re-start at a lower dose: http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=50351

Due to consistently high PS#'s and seeminly acceptable nadirs I have decided to re-start at a lower dose to rule out rebound due to too much insulin.

This morning was our 3rd cycle on 0.6U (using U100 so easier to dose 0.6 vs. 0.5). PS#'s so far in the red zone instead of black. Yesterday his BG shot up from 368 at +4 to 555 at +6 after a feeding, but came down to 400's at PMPS time. There was a promising drop last night at +4 to 283 but again shot up to 447 after feeding and seemed to maintain that # to this morning (did not test in between).

Today's +2 to +6 curve have been in the 300's without much dip. Ketone (-) this morning. Attitude mellow but would engage in playing with a stringed toy; hunger and urination frequency/amount seemed to decreased a bit compared to yesterday (will have definitive measures tomorrow morning when I sum up his 24hr water/food intake).

I know it can take a few cycles (up to 3 days) for the rebound effect to go away but just want to check with the board memebers that his #'s so far are acceptable to continue at the 0.6U for a few more cycles since high BG# > 300 (?) are supossedly toxic to the organs?
 
Alicia
i am on my phone and can't look in his log. But Bob had preshots over 300 and low 400s for at least a month before i ever saw. 200s.
Carl
 
Hi Carl -- thanks for your input. During the time Bob had PS#'s in the 300 and 400's, were his #'s lower during the mid-cycles?

Here are the #'s for the past week since we increased from 1.2U to 2.0U per vet recommendation. We stayed on 2.0U for a total of 9 cycles and even though his nadirs look pretty good, his PS# are too high for my comfort. Yesterday morning is the 1st cycle of reduced dose at 0.6U.

Mon 8/15:
AMPS - 452 got 1.2U
+5 - 188
PMPS - 493 got 2.0U per vet
+2 - 306
+4 - 145 ate 1/2 can FFC
+6 - 105 ate 1/2 can FFC

Tue 8/16:
AMPS - 536 got 2.0U
+5.5 - 166
PMPS - 443 got 2.0U
+4 - 177 ate 1/2 can FFC
+6 - 158 ate 1/4 can FFC

Wed 8/17:
AMPS - 403 got 2.0U
+5.5 - 145
PMPS - 516 got 2.0U (fur shot?)
+2 - 503
+4 - 299

Thu 8/18:
AMPS - 524 got 2.0U
+6 - 156
PMPS - 520 got 2.0U
+2 - 351
+4 - 144

Fri 8/19:
AMPS - 522 got 2.0U
+5.5 - 228
PMPS - 472 got 2.0U
+3.5 - 214

Sat 8/20:
AMPS - 516 got 0.6U (1st cycle of reduced dose)
+2 - 391
+4 - 368 ate 1/2 can FFC
+6 - 555
+11 - 412
PMPS - 480 got 0.6U
+2 - 372
+4 - 283 ate 1/2 can FFC
+6 - 447

Sun 8/21:
AMPS - 442 got 0.6U
+2 - 373
+4 - 339
+6 - 396 ate 1/4 can FFC
+8 - 413
 
Very nice. The thing that jumps out at me is that every PS since you started the lower dose has been lower than the previous PS. I would stick with the .6u and let the rebound hormones clear his system and re-evaluate the dose then.
 
Hi Alicia, I actually think you are getting decent #'s off the lower dose but I agree you need to hold for a little longer to know what Beau likes .... a little? or a little more? you haven't been on this dose long enough to know for sure.

And I hate to keep mentioning this .... maybe people from Orange county have less patience! (sorry I couldn't hold that in any longer ... I was born and raised in LA and we were the best! Orange co., the valley, no way!)

But patience is important but you sure keep good records, are you going to set up a spreadsheet?
 
alicia.1771 said:
Hi Carl -- thanks for your input. During the time Bob had PS#'s in the 300 and 400's, were his #'s lower during the mid-cycles?
Click to expand...

Unfortunately Alicia, I don't know the answer to that question. From May when he was diagnosed until June when I joined this board, I had little clue what I was doing. While my vet suggested and showed me how to home test, I was only told to test him pre-shot in the am and pm. So he never had a curve done when his numbers were that high. His dose went from 1u BID to 4u BID in that time period, based solely on directions from my vet. She's one of those "line in the sand" people. "If Bob is 300, then shoot 3u, if he's 200, shoot 2, if he's under 100, call me asap."
When I joined here, the first thing I did was figure out I needed to start cutting back his dose because he wasn't going any lower at the high doses (he was getting too much insulin and his liver didn't like it.)
I started reducing his insulin, and started testing more often. His curves at that time were never really big dips. He didn't drop from 300 to under 100 on 2 or 3 units. Even when he was almost OTJ, and I was shooting 2u into a 100, he never fell below 45-50. I just looked, and I once shot a 3u dose into a 176, and his low at +5 was an 84, and at +12 he was 184 (at which time he got another 3u. That was on June 26th, and 3 weeks later I shot a .5 into a 78 and that was his last insulin shot.
I can't possibly stress enough how Bob is a perfect example of ECID. I have never, nor would I ever, give dosing advice based on Bob's history. Not in terms of how much to shoot anyway. If I shot .6 into Bob when he was at 400, he would have spit it out and asked "what else you got?"
Any time I have advised someone to shoot or not shoot, or increase or decrease, the only things I look at is that cat's specific SS and history, and I also take into account what I have read other people say about certain types of insulin or other conditions beyond diabetes like DKA for instance. I have learned a million times more about FDB by observing other people's cases and all the excellent advice that is dispensed here daily than i ever learned from treating Bob. I learned the mechanics by doing it myself, but the logic and understanding of how diabetes works and how we make it better, I've learned that just from being here every day. Y'all are teaching me every day.
Alicia, you are doing a fantastic job with Beau. It's just going to take a while to get where you want him to be. Just keep it up, and listen to the great advice you are getting every time you ask for it. Also, don't be afraid to trust your gut, especially when you need a fast answer and nobody is here to help. That doesn't happen often, but it will.
Carl in SC
 
I had to chuckle at the comment .....on .6...."spitting it out and saying is that all you got!" I can relate----it sounds like Kitty! :lol:
 
I personally would take up the dose after spending 3 days at this dose. You are barely getting a drop in numbers with this 0.6u dose. Back starting on the pm dose for 8/10 you got several red preshots in a row there too, and that was at the 0.8u dose. Starting on 8/14 you also got several red preshots in a row there too on a 1u/1.2u dose. My point in writing that is to point out that in my just be the natural cycle of things too and not necessarily due to a reduced dose. You are getting a very short duration right now (roughly only 7 hours), which also points to too little insulin. I hope to be proved wrong with this cycle :-D but I really think this is a case of not enough insulin. Have you been able to talk to your vet about a dental for Beau?
 
Sun 8/21:
AMPS - 442 got 0.6U
+4 - 339
PMPS - 478 got 0.6U
+4 - 307

Mon 8/22:
AMPS - 429 got 0.6U
+6 - 369 (time to increase dose)
ketone (-)

Hmm....it looks like we ruled out rebound, he needs more insulin.

Just eamiled the vet reg. dental and dosage. Most likely she'll put him back on 2.0 or higher and hold it for longer as he did get decent nadirs on 2.0. Perhpas the big swings on PS's would have leveled out had I hold the dose for longer than 9 cycles??? Well....the dance continues....
 
Alicia
please don't go from. 6 all the way up to 2 or more. You may miss the right dose. If you feel an increase is needed(remember. trust your gut) why not go. 8 or 1.0, then keep it there for like four days unless you see him go too low in the middle?
carl
 
For tonight's PM dose I'm thinking of either 1.0 or 1.2 since he barely got any drop on 0.6, I'm not sure 0.8 is going to do much for him and his #'s have been very high for 3 days now I'm afraid it's not good for him.

I really don't know :? , I'm going to put more thoughts to it. We have another 3.5 hours to go before PM shot. Anyone else have advise on tonight's dose???
 
Have you gotten anything back from the vet on the dental and dosage?

carl
 
OMG!!! 1st pink PS# in over 10 days!!!

PMPS 362 and 384 --> I took it twice because I couldn't believe my eyes :shock:

This is a tough call...maybe I will give him 0.8U tonight???
 
Hey Carl - honestly? I think he was rebounding perhaps since 7/29 as that's when his #'s started to go haywire. But then it could just be me reading too much into the #'s and being hopeful that he is sensitive to insulin and doesn't need that much of a dose. It's hard for me to tell as his clinical signs (appetite, urination, water consumption, etc.) seems to go up and down and that (I think) it's due to the high #'s and can either be from the rebound or too little insulin.

I ended up giving him 0.6 tonight just so we have a full 3 days on the reduced dose and give the rebound (if it is even so) a chance to clear out of his system. I may regret this decision tonight or tomorrow morning (as I seem to be doing that a lot lately :sad: ) if his # turned out to be terrible, but it seems like most of the time there is no right or wrong answer and we just have to go with what we think is the best for our kitty and pray that it will not make them worse. But what makes this soooo difficult is that most of the time I honestly don't know what is best for Beau...I think I'm one of those people who is so afraid of making a mistake that I end up making more mistakes... :lol:
 
Alicia,
For the record, I looked at Beau's SS a few minutes ago and saw you had shot a .6, and I thought "good girl!"
I agree with that choice, but I wasn't going to tell you to do that. I was hoping you made the decision, and the reasons you said were what I was hoping would be your reasons. I thought at least 3 whole days would be a good idea.

And no, don't regret it no matter what his number is in the morning. You had to "know", and there isn't a bad consequence to that choice. At worst, he'll have a high BG. If he's high, then maybe you could kick it up to 1.0 and try that for three or four days. And then you'll know if that's a good dose for him. Going up and down, and doing it every day or every other day just makes everything so much more confusing. The more consistent you can be, the more sense his SS will make in the long run. Eventually, you'll find that perfect dose, you'll see a big improvement, and he'll really start to show signs that he's ready to be all better. If you approach this conservatively, you aren't going to make a real bad mistake. Little mistakes along the way are going to happen. ECID, and EBID. Don't be afraid of making little mistakes. Making mistakes is the best way to learn. Not just in the sugardance, but in anything.

Anyway, good call, in my opinion.
Keep up the good work!
Carl in SC
 
Hey Carl - just want to thank you for the kind words of encouragement, it has brought much comfort to me during this difficult time. I was so relieved to see another pink PS this morning and again tonight, even more so that it seems to be coming down slowly. Life with a sugarcat sure isn't easy, but I'm learning a little bit each day and hoping to be a little more brave with each step :)
 
I took a look at Beau's SS this morning, It looks like he had a good pm cycle! Yay for blue!

The lower dose looks to be working well!
 
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