Calibrating Dosage

KrisQ

KrisQ

Member
Hi All - Kallie is back OTJ after a nine month absence. In the morning, she's generally been in the low 300's, I dose her with 1 unit and her PM reading is usually under 200, sometimes the low 200's. But she bounces back up into the low 300's overnight into the next morning.

I'm wondering if I shouldn't be giving her .5 in the AM and then if her BG is above 200, give her another .5 in the evening so that she's getting insulin twice a day? On the other hand, I'm pretty happy with the way things are going so far and am hoping to jumpstart her pancreas.

Thoughts?
 
I'd definitely find a dose you can shoot consistently twice daily and 0.5u morning and night seems a good place to start but you may need to back down a bit more because some of what you are seeing right now in those AMPS numbers is likely bouncing from not giving the shots twice daily. You could try 0.25u twice daily for a few cycles and then increase to 0.5u if need be.
 
MrWorfMen's Mom said:
I'd definitely find a dose you can shoot consistently twice daily and 0.5u morning and night seems a good place to start but you may need to back down a bit more because some of what you are seeing right now in those AMPS numbers is likely bouncing from not giving the shots twice daily. You could try 0.25u twice daily for a few cycles and then increase to 0.5u if need be.
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Thanks - I'm going to start at .25 and see what happens for awhile - appreciate the advice!
 
338 this morning, dosed .25. Home 10 hours later and BG was 317. Hmm. Dosed .5. Will keep at .5 for several days to see what happens. Her appetite is not great - she eats, but not her usual OMG you left me and I'm starving routine. Her water intake is normal though, so I'm taking that as a good sign.
 
Her numbers have been all over the place, but mainly higher than I'd like this week. 359 this morning, gave .5 units this morning and when I got home her BG was at 415, so I gave 1 unit and will watch her tonight. Her appetite is ok, and her water intake has not increased, so I'm unsure of what's going on here. Her behavior is stable, nothing out of the ordinary. We're out of town for half of the weekend, so I was hoping to have a better pattern before we left.

I welcome your thoughts and thank you.
 
I still think you need to find a dose you can consistently shoot twice daily and it appears 0.5u is still too high and can lead to a low pre-shot that makes you skip a dose. I see you reduced the dose to 0.25u on the AM cycle of the 19th but then you immediately reacted to the higher AMPS on the 20th and increased to 0.5u again.

The interesting and confounding thing about insulin is that a dose that is too low and a dose that is too high can look almost the same. Insulin is a hormone not medicine so it doesn't work like 1 vs. 2 aspirins. You are reacting to a higher number when it is the product of a dose that appears to be too high.

My thinking is that some of those higher pre-shots you are seeing are from a bounce which is a natural defensive reaction when kitty drop to levels they perceive as too low which is relative, dropping quickly, or BG that has dropped too low. You don't have any readings taken in the time frame when ProZinc would normally be expected to reach its peak action (lowest BG of the cycle) and that is what you need to determine to figure out the best dose for Kalllie. ProZinc usually reaches peak action between +4 and +7 post shot. Getting BG levels in that timeframe will tell you how low Kallie is going in a cycle and when her nadir (lowest point) often occurs.

The other testing I would recommend is a before bed test EVERY night. Our extra sweet kitties tend to run lower at night than they do during the day so it's vital to get some data even early in the night cycle to see a better picture of what is happening overall.

I would recommend backing off to 0.25u for at least 4 to 6 cycles and getting mid cycle tests when you can in the +4 to +7 timeframe and also getting at least one test in before bed every night to get a full picture of what Kallie is up to.
 
MrWorfMen's Mom said:
I still think you need to find a dose you can consistently shoot twice daily and it appears 0.5u is still too high and can lead to a low pre-shot that makes you skip a dose. I see you reduced the dose to 0.25u on the AM cycle of the 19th but then you immediately reacted to the higher AMPS on the 20th and increased to 0.5u again.

The interesting and confounding thing about insulin is that a dose that is too low and a dose that is too high can look almost the same. Insulin is a hormone not medicine so it doesn't work like 1 vs. 2 aspirins. You are reacting to a higher number when it is the product of a dose that appears to be too high.

My thinking is that some of those higher pre-shots you are seeing are from a bounce which is a natural defensive reaction when kitty drop to levels they perceive as too low which is relative, dropping quickly, or BG that has dropped too low. You don't have any readings taken in the time frame when ProZinc would normally be expected to reach its peak action (lowest BG of the cycle) and that is what you need to determine to figure out the best dose for Kalllie. ProZinc usually reaches peak action between +4 and +7 post shot. Getting BG levels in that timeframe will tell you how low Kallie is going in a cycle and when her nadir (lowest point) often occurs.

The other testing I would recommend is a before bed test EVERY night. Our extra sweet kitties tend to run lower at night than they do during the day so it's vital to get some data even early in the night cycle to see a better picture of what is happening overall.

I would recommend backing off to 0.25u for at least 4 to 6 cycles and getting mid cycle tests when you can in the +4 to +7 timeframe and also getting at least one test in before bed every night to get a full picture of what Kallie is up to.
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That's great advice, thank you. Your point about being a hormone and not medicine is really good feedback. I had started reading some other posts and was wondering if more testing was called for. What's weird is that this is completely different from how things went after her initial diagnosis last November. We'll be gone for part of the day and tomorrow, so that stinks. But I'll start back with .25 track and see where it takes us. The good news for my sanity is that she has an appetite and her water consumption is not ridiculous, so we'll keep plugging away until we find the right dose. Thanks again and have a great weekend.
 
I've been puzzled by Kallie's numbers. Things were starting to look good with the .25 injections twice a day but then boom - up went the numbers. So, I've bumped up to .5 twice per day - should I have gone down and not up?

I've been home the last two days and have noticed that she's not eating all of her food first thing, she's been snacking 3-4 bites from a few hours after to six or seven hours after and it's all gone by the time I usually get home. Could that be accounting for her evening numbers, but it makes no sense with the higher morning numbers... I'll try to get her BG again in a few hours, if she will entertain the idea. Since I'm generally not at home during the day, should I cut her food portion from 1/2 can to 1/3 can twice per day for awhile to see if that helps?

On the whole, she seems fine. She's a purring, happy furball with a normal water intake. Her human is a hot mess trying to figure this out.

Thoughts and advice appreciated!
 
Your SS shows a lot of testing at +10/+11 on day cycles but no pre-shot tests for the PM cycles. A pre-shot is crucial and needs to be done without any food influence to truly understand how a dose is working for Kallie. A lot can happen to BG in 2 hours so shooting based on a test 2 hours before the shot could lead to shooting too low a BG and cause bouncing or worse.

Pre-shot tests need to be done immediately before shots and at least 2 hours after last food. If you aren't home to allow for 2 hours between food and shot time, an auto feeder would be a good investment. There are also no before bed tests so we have no idea what she is doing at night. It may be she needs more insulin or less insulin but I can't tell which way you need to go based on the testing you've done. What you are seeing could be bouncing from low BG that you are not catching because of the testing you are doing.

You need to know how low a dose is taking BG. Dosing cannot be based solely on pre-shots or close to pre-shot tests later in the cycle. Whenever you can, grab tests between +4 and +7 hours post shot and always get pre-shot tests (+12) and a test before bed every night.
 
Ok, got it. I'll start today. Will be able to pre-bed numbers the rest of the week. Thank you!
 
I was able to get several bg tests done Sunday but missed getting anything last night. Do I simply need more data before trying to draw any conclusions? The only experience I have with her is the initial diagnosis and she went into remission soon after. I'm worried that I'm not doing something correctly, although I understand that each situation is different, I'm frustrated and concerned.

Routine: Get up, check bg, feed, inject, go to work. Get home, check bg, feed, inject, work some more, should test again, bed. On weekends, I should test more often. What am I missing...
 
That red start today may indicate that Kallie went lower at some point last night and is now bouncing (we don't know because there is no night test) or it could be she needs more insulin. It also looks like you shot based on a test at +11 rather than +12. While it doesn't look like BG would have changed much if you have a choice, test at +12, feed and then give insulin.

I'd hold the dose for today, get a minimum of a before bed test tonight and then we can see if that provides any clues as to what Kallie is doing at night. If it's possible, if you get up during the night, grab a test then. Some folks set an alarm to try to get a later test at night periodically.

Your planned routine looks fine. Test mid cycle whenever you get the opportunity but ALWAYS grab that before bed test and do pre-shot tests at +12 post previous shot. You have up to an hour of leeway with shots with ProZinc so don't worry about being 15 or 30 minutes early or late due to work schedules. It's tougher when you are working but use the time you are home to fill in the gaps in info.
 
MrWorfMen's Mom said:
That red start today may indicate that Kallie went lower at some point last night and is now bouncing (we don't know because there is no night test) or it could be she needs more insulin. It also looks like you shot based on a test at +11 rather than +12. While it doesn't look like BG would have changed much if you have a choice, test at +12, feed and then give insulin.

I'd hold the dose for today, get a minimum of a before bed test tonight and then we can see if that provides any clues as to what Kallie is doing at night. If it's possible, if you get up during the night, grab a test then. Some folks set an alarm to try to get a later test at night periodically.

Your planned routine looks fine. Test mid cycle whenever you get the opportunity but ALWAYS grab that before bed test and do pre-shot tests at +12 post previous shot. You have up to an hour of leeway with shots with ProZinc so don't worry about being 15 or 30 minutes early or late due to work schedules. It's tougher when you are working but use the time you are home to fill in the gaps in info.
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Thanks for the help. It is difficult sometimes with my schedule... I'm generally home ten hours after first AM and she's "starving" but I've made her wait tonight and that's my plan moving forward. Let's see what happens...
 
Once you get Kallie better regulated withholding food for 2 hours pre-shot isn't as vital. In the meantime have you considered an auto feeder so you could leave food for her to eat while you are gone so she's not so hungry when you walk in the door. I get the problem....it's darn near impossible to look in those eyes and say NO.:blackeye:
 
I've not seen an auto feeder for wet food, I had one for dry food. Will look into it today, appreciate the tip! It is hard to say no. I'm not as home as much as I'd like and have Mom guilt... Adjusted my calendar for the next few weeks so I can be here and keep an eye on her.

So, I took her 12 pmps at six (335) with no shot and then at 9 before bed (405). It was down to 335 this morning - so that means that the dosage had been too high? Or have I got that backward? Shooting .1 instead of .25 just in case this morning.
 
It might but not necessarily. You can't make judgement calls about dose based on what happened on one particular night. Most cats run lower at night and that lack of a sustained rise in Kallie's BG between PMPS last night and AMPS today could just be that phenomenon. Try the 0.1u dose for a couple of cycles but if BG continues to rise, then I would increase it back to 0.25u. The sooner you can get her BG down the better the chances of getting her back into remission.
 
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