Curve almost done. Appreciate dosing advice

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Likameow

Likameow

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So I'm almost done doing another curve on Ben. And I'm still trying to figure out what is the best dosing schedule/amount for him. I'd appreciate any advice you all can give me. He eats a can of FF classics after each AMPS/PMPS and then free feeds on Young Again Zero Carb during the day. But he doesn't eat much of that.

Thanks, Lisa
 
The insulin is working. He gets a good drop. He does have room to drop more. I think I'd either increase the dose by .25 overall for 3 cycles and then up agqin if needed or do a sliding scale - giving 1.25 for pinks and 1.5 for reds. Any change should be made on a day you can monitor. Is he still on antibiotics? If so, that can definitely increase his numbers.
 
He just finished the antibiotics yesterday. I upped his dose to 1.25 tonight. I see what he does for a few cycles. The couple of times I tried the sliding scale he bounced badly. Thanks for the advice.
 
Upped his dose again to 1.5 and he seemed to flatten out. So probably too much? Doesn't he realize that this would be much easier if he was consistent?!? @-) I won't be able to monitor him for the next couple nights since I'll be at work so I'm not planning anything drastic until the weekend. Plus on Friday, my half unit U100 syringes will arrive so I can be more precise with his doses.
 
The smaller dose does look better. I guess keep with this amount until the weekend and then decide - sliding scale or smaller dose……… The next few days should tell you whether he needs time to adjust to a dose and then drops or whether he needs less insulin for the lower numbers and more for the higher.

Do you do ketone tests? If not, I would get one every few days. Anytime they are running higher, you just want to be careful. You use the ketone strips that humans use. Oliver would never pee while we were watching so we can to give him a clean box filled with aquarium gravel which he would christen, and then we would run in and get the sample.
 
Thanks for always being there for us, Sue. I have been checking for ketones. He's always been negative (except a trace when he had the UTI). Luckily, he doesn't care if I come up behind him with the "pee stick" while he is in the litter box so I just keep the bottle near it and follow him in. And he so nicely pees right on it. I must admit that aside for the dosage "dance", Ben really has been a rock star about all of this.
 
I swear that Ben can tell when I have a plan and feels like he must modify it. His PMPS was 299 so I gave him 1.2 instead. I'll see what that does to the AMPS. Silly kitty.
 
Throwing a curve ball! They love to do that. Definitely a sugar dance!!!

The AMPS will be interesting. Should help tell you if a sliding scale is a better option. You're doing great!!
 
[quote="Rachel"The AMPS will be interesting. Should help tell you if a sliding scale is a better option. You're doing great!![/quote]

And the AMPS was (drum roll, please).....591! grr_red So I gave him 1.5 U before I headed to bed.
 
That has to be a bounce! He was at 299 at +7, right? So he probably kept dropping after pmps - he was technically dropping the whole cycle after the high amps yesterday. Shooting a dropping number could have meant adding insulin when there was already some on board (a long cycle dropping still at pmps usually indicates too much insulin the shot before - the insulin is lasting longer than usual. Normally ProZinc has a smile curve with nadir low in the middle.)

I know this is frustrating but hang in there and keep muttering, "data gathering, data gathering". I think your dose today is okay - you need him to come down, but I am leaning toward a lower dose overall. This is all about diguring out his patterns - what the insulin at a given dose does for him.

Lets's see what tonight's pmps looks like. If he is dropping still, I'd stall and see if he starts back up or continues to drop. If he is still dropping, I'd see if I could catch the rise so you know what is really going on. (did he drop low after the shot last night and was the +7 the rise or was he in the 200s the whole cycle)I'd lower the dose to one unit if he is in the yellows.
 
Sue and Oliver (GA) said:
Lets's see what tonight's pmps looks like. If he is dropping still, I'd stall and see if he starts back up or continues to drop. If he is still dropping, I'd see if I could catch the rise so you know what is really going on. (did he drop low after the shot last night and was the +7 the rise or was he in the 200s the whole cycle)I'd lower the dose to one unit if he is in the yellows.
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I have to do something at the +12 mark because I go to work right after that. Sometimes, I can get away to check him at either +4-5 or +6-7 but not always. Should I just go with 0.8 since it worked pretty good for him before?. And more questions. If the PS is red and drops about 50% into the yellow which would indicate a good dose, will the PS eventually drop into the yellows using that same dose? I guess what I'm asking is...am I trying to get him into normal numbers too quickly?
 
Likameow said:
I have to do something at the +12 mark because I go to work right after that. Sometimes, I can get away to check him at either +4-5 or +6-7 but not always. Should I just go with 0.8 since it worked pretty good for him before?. And more questions. If the PS is red and drops about 50% into the yellow which would indicate a good dose, will the PS eventually drop into the yellows using that same dose? I guess what I'm asking is...am I trying to get him into normal numbers too quickly?
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If he is dropping into the yellows at pmps instead of heading up, I guess the .8 would work. At least, it would let us see whether it lessens the bounce for amps?

Not that easy :mrgreen: If, for example, 1.5 at a red pre shot drops him 50%, yes it is a pretty good dose. A 1.5 on a yellow would likely be too much, maybe drop him too low and cause a bounce. The way that constant dosing works best is when you are in pretty flat ranges for amps and pmps and one dose can work for both shots. When he is bouncing from yellows to reds, the same dose for each shot can set you up for bouncing.

The best way, I think, for you to see how different doses might work is to check out some ProZinc spreadsheets. Merlin's is especially similar to Ben. He bounced all over. She just kept getting data and adjusting doses, and it took awhile, but he is now on mini doses and not bouncing at all. The way I see this dance: Sometimes a cat will be diagnosed, change food, start dropping in bg levels, get a week or so of shots and go off insulin. That is pretty rare but does happen. The majority, on each type of insulin, take months to adjust to the insulin in combination with the food. We mess around with dosing, hoping we hit the perfecto, when he is taking his time. :mrgreen: He bounces and we try to help, but the ugly truth is Ben will bounce until his body starts to recognize that lower numbers are okay. After awhile, he starts to be more consistent with numbers and we can dose more effectively and he starts to drop, needing less insulin. So, to make a long story short :mrgreen: Yes, patience helps. And hurrying just frustrates. Your job is to collect data, keep him in safe numbers and try to find a good dose for every pre shot.

The biggest truth on this site is: Every cat is different. Their journey is different, their numbers are different, they react different to food, stress, insulin - everything. I love this word picture: This is a sugar dance. But only the cat hears the music. You just try to catch the rhythm.
 
Just checked him again at the +9 mark and he is 564. It was originally "Hi" on the glucometer but I checked it again (twice) and got 564. So now what? Still go lower and treat it like a bounce?
 
No, he went down and back up so I am assuming this is not a bounce. I do think the last few cycles have been weird with some long ones, some lower numbers, some bounces. What would you think about 1.25 and see what happens with that?

There are cats that react to a bounce a cycle or even two after, which complicates things. (Merlin did this often.) Since you can't monitor until the weekend, I would just try to shoot the number with a dose that has worked before and hope he settles in.
 
*taking a deep breath* I'll go with the 1.2 (easier with U100 syringe) until I can monitor more closely. Might work some OT this weekend to help pay for this silly sugar cats treatment. But I promise to wear my patience pants and sway to Ben's rhythm. Guess I'm all worried about him being hyp when I'm at work but he really hasn't had that problem so I think I just need to stop stressing about that.
 
You just gotta get a nice pair of patience pants! He has had strange cycles lately. Sue has all the good ideas but I wanted to stop and say hi!!! :)
 
Rachel said:
You just gotta get a nice pair of patience pants! He has had strange cycles lately. Sue has all the good ideas but I wanted to stop and say hi!!! :)
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Hi, Rachel. Patience pants on! I got my half unit syringes today so I'm ready for small adjustments if I need to. I need to remind myself that although his numbers aren't ideal, Ben is feeling good. Just tried to steal a piece of pizza from me. (As I was typing this, I heard a sound from the kitchen and busted him eating a piece of stolen pizza. So I am anticipating some increased sugars tonight) Which is more typical for him than the 'mellow' cat he has been. I'm going to give the sliding scale a try again. I will figure this cat's rhythm!
 
Hey Lisa. Just wanted to say that Ben is one lucky cat to have you. I see that Sue mentioned Merlin's SS and his similarities with Ben. So I was looking at Ben's SS and he does look like Merlin. I thought I would share with you a few things that I have tried.

Merlin was all over the place for a very long time. I never thought I would see consistent, let alone "expected" numbers. Sue has helped me along and I remember her saying; collecting data is a good thing. So even though I did not get the numbers I wanted, it was giving me good data for keeping him safe and for building a scale for future doses.

As I said, Merlin bounced all over the place at first. It was like he was afraid of getting down into those blues and greens. When he did, he bounced for days. Today if he bounces, it is usually for one cycle (12 hours). For him, it was just a matter of his body getting used to being in lower numbers. At first I tried consistent doses, then sliding scale, then consistent doses, then sliding scale, back and forth...you get the picture. I think I went back and forth at least six or seven times. I found with him that in order to stop the bounces, I would have to give him consistent doses (unless the PS was really out of the ordinary) for at least six cycles (three days or more...sometimes a week) then I would either try another consistent dose or try a sliding scale. So even if it was a higher number, I would give him the same dose as a lower number. It seemed to "right" his body's reaction to the insulin. Then I would have collected enough data to start a sliding scale. That would work for a while then he would start bouncing so I would go back to consistent dose, then he was ready for the sliding scale again. Each time I would update the sliding scale. It seems weird but that was just Merlin and it seemed to work for him. I do that still today, i.e. I may go to a consistent dose then start another sliding scale. Right now, he is on a sliding scale. Oh and also, I would start building my sliding scale on my spreadsheet so I can continuously update it and refer to it easily. You can see several of them on the comment section of my SS.

Every time I shoot a new dose for a new number, I test at +2 to check out his reaction to it. If it is higher or even equal than his PS number, he probably will run safe that cycle. If there is a quite a drop, then I will need to check him either at +3 or +4. Merlin nadirs for the majority of time at +5 or +5.5 so I try to get a +5 number to see what his lower number is. If the +5 number is good, then that is how I set my sliding scale. If I get the same reaction twice, then I update my sliding scale or note that this is a good dose for that number.

Anyway, I am rambling but it took me a long time to get there. For Merlin, it just took that long for him to accept lower numbers and for me to figure out what the heck I was doing. If Ben is like Merlin, he is going to continue to give you unpredictable numbers but sooner or later, he will settle in and start giving you good results.

Oh one more thing that I noticed on Ben's SS that is similar to Merlin's, is that lower numbers did seem to give you better results. It looks like .8 back a few weeks ago got you lower numbers. If I gave Merlin too much, he would also run flat and high like you are seeing here recently. Sue mentioned that too. It is weird that sometimes less insulin is better. So just a thought, you could try a consistent .8u for at least three or more cycles and see if Ben settles into that dose.
 
Just in case you need them


Courtesy of Deb and Wink.
 

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Merlin said:
Hey Lisa. Just wanted to say that Ben is one lucky cat to have you. I see that Sue mentioned Merlin's SS and his similarities with Ben. So I was looking at Ben's SS and he does look like Merlin. I thought I would share with you a few things that I have tried.
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Thank you so much for your insight. I love hearing that I am not alone in this journey. Ben and Merlin do sound like kindred spirits. I'll employ your techniques for awhile and see how he does. I guess what is hard for me is that I'm trying to treat him like the diabetics at work (a hospital). But much as I treat him like my furry child, I need to remember that he is a cat and might have different reactions to the meds.


And BJM, I promise to have extra patience to keep from having to wear those! :-D
 
Hard to tell what is happening. The .8 brought down that high black but didn't work as well on the pink yesterday am. Still need more data but he seems to drop lower at night.

Tell us about feeding. Does he get small frequent meals or two daily? Is he fed the same way at night?

I am torn. I hate to see him in those high numbers, but am unsure whether the dose needs to be raised or held for another cycle.
 
Sue and Oliver (GA) said:
Hard to tell what is happening. The .8 brought down that high black but didn't work as well on the pink yesterday am. Still need more data but he seems to drop lower at night.

Tell us about feeding. Does he get small frequent meals or two daily? Is he fed the same way at night?

I am torn. I hate to see him in those high numbers, but am unsure whether the dose needs to be raised or held for another cycle.
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He gets a can of FF morning and night when he gets his insulin. There is also a bowl of young again zero carb dry food that he is free to snack on.

I'm home today so I plan on getting a curve done on the 0.8U dose. No obligations so I'm hoping to do a 24 hour one.
 
Yeah I have had those high numbers (higher than PS numbers) at +2 too. It happens a lot for Merlin's PM shot and some for AM. I contribute it to me more likely to feed Merlin more often in the morning i.e. 6am, 6:30am, 7am, 8am, 9am, and one more time before 11am. Then I probably will feed him around 2pm and 3:30pm (all little meals with lots of distilled water in it). At night, he doesn't seem to be as hungry so I may feed him only at 6pm, 8pm and one more time before I go to bed at 10pm. It wasn't just a few days ago that Sue suggested to feed him a few more times after midnight (I feed at midnight and 3am now) and that seem to have help lower his AMPS numbers. So food may have something to do with the higher +2 number and sometimes it just takes that long for the insulin to start working because in the AM you're number is rising. The high +2 number is also telling you that you won't have a lively cycle so will not expect to see lower numbers at nadir (at least I have never seen it).

I am wondering if the dry food (YA) has anything to do with his higher numbers? I have seen advice on this board that no dry food should be used, even YA with 0 carbs. I don't have any experience with the YA dry food so I really don't know.
 
Looks like he is pretty bouncy.

And possibly, you are not getting long enough duration. (Sue - what do you think?)
If duration is the issue, there are 4 options:
1) live with it; it may resolve eventually
2) consider dosing about every 8 hours (TID)
3) switch to a depot insulin - Levemir or Lantus
4) use a bolus insulin to cover the hours where the insulin is wearing off.
 
Merlin said:
I am wondering if the dry food (YA) has anything to do with his higher numbers? I have seen advice on this board that no dry food should be used, even YA with 0 carbs. I don't have any experience with the YA dry food so I really don't know.
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He doesn't eat much of the dry. The wet seems to fill him up. It is more for the other cats so I don't have to try to keep him out of their food.

BJM said:
Looks like he is pretty bouncy.



And possibly, you are not getting long enough duration. (Sue - what do you think?)
If duration is the issue, there are 4 options:
1) live with it; it may resolve eventually
2) consider dosing about every 8 hours (TID)
3) switch to a depot insulin - Levemir or Lantus
4) use a bolus insulin to cover the hours where the insulin is wearing off.
Click to expand...

Option 2 is out, I work 12 hour night shifts at the hospital.

Hoping that Option 1 is the solution. Tomorrow is his 1 month anniversary of starting insulin.
 
Still rising. So now, I'm wondering about a "fur shot". I've never that problem before but there is a first time for everything. So I think I'll abort the day time curve. I'll check him at +5 and +7 then restart the curve tonight. Haven't done a night curve before.
 
That sounds like a good plan. If not a fur shot, then maybe it will be that you should go for more insulin rather than less. Let's see what the pm cycle looks like. (he has bounced around with dosing as well as the bouncing his body has done, so it is hard to see exactly what is going on - yet) I think time will tell.
 
Dropped to 324 at +7 so he must have got his insulin. What is your thoughts about a more aggressive sliding scale? Something like 1.6U for blacks, 1.2U for red, 1U for pink. Just wondering.
 
That kind of a curve - not a smile, but a dropping line often means the dose is too high. But usually it is at lower numbers. I am confused, but bet he'll show us if we are patient....
 
Coming back up at the +9 mark. Any ideas for night dose? I'll be home all night and can do another curve.
 
I asked Jen to take a look. She used PZI and was good at deciphering spreadsheets. He is clearly too high still but I wonder if we'd leave it at .8 and you'd get nightime numbers, what you'd see. You have a while before pmps, right?
 
Looks like Jen isn't around. I think it's her birthday!

How would you feel about giving .8 one more time, while you can get overnight numbers? That should tell us once and for all whether the dose is too low and we need to raise it or if he drops low overnight and bounces.

If no low numbers tonight and higher tomorrow then I am definitely on board with trying the scale at higher ranges.
 
Perfect timing, Sue. Was just getting ready to give Ben his night time shot. So I'll go with 0.8U and well see what happens. *fingers crossed for helpful information* I appreciate all your help and input.
 
Hi Lisa!

Sue asked me to take a look at Ben's SS to see if I can take off my Lantus thinking cap, and put back on my ProZinc thinking cap. ;-) My guy Eddie was on ProZinc for about four months before we switched to Lantus. Eddie had some complicated dance maneuvers while he was on ProZinc, and he still does on Lantus. :lol: I try to pop into the PZI forum to say hi once in a while, and check on some of Eddie's PZI buddies. :-D

So, a couple things I'm seeing...Ben did look better at a lower dose a few weeks ago, when he was hitting greens. However, there doesn't appear to be any green numbers for about three weeks now. I read somewhere that kitties often have a "honeymoon" period when they very first start insulin, where their numbers really look great right away, and then they sort of settle into needing a higher dose. I'm wondering if that might account for the greens in his first couple weeks on insulin.

Right now, to me, it looks like you have room to increase the dose - the caveat being that I'd wait to do so until you can monitor fairly closely...including at least 2-3 tests during the night time cycle. Kitties can "bounce" for six full cycles (sometimes even more), after a low number (or lower than they're used to), so if you happen to miss a lowish number during one night time cycle, the next six cycles can all look red and pink as a result of bouncing off a low - making it appear that the dose isn't high enough. For example, I wonder what Ben did during the PM cycle on 9/17. It's possible that he may have already been on his way back up at the +7 you got that night after going lower. Hard to say. I don't see anything that's super obvious to suggest low numbers during some of the cycles that there aren't any mid-cycle tests, other than some black pre-shots - which to me - say bounce. For example, Ben may have hit lower numbers during the PM cycle on 9/19 or the AM of 9/20.

Do you work days or nights? I work full time too, and I was (and still am) pretty aggressive with dosing, so even though my ability to test during the day time while I'm at work is pretty limited, I get as much night time testing in as I can so as to try to spot patterns. One thing we recommend with Lantus, that IMHO may be a good idea with ProZinc too is to shoot a little earlier in the AM (if your schedule allows), to try to get one extra test in at +2 or so before you head out for the door for work. A dropping number at +2 can signal a "busy" cycle, and some kitties seem to drop like a rock super early in the cycle if the dose is too high, and then start to head back up well before +6. That's another pattern that can make a kitty look flat when they're really not.

I'm a big fan of sliding scales, but for the moment, I'm thinking that you may want to try hone in on a dose that's at least in the ballpark, and then tweak with a sliding scale from there.

That's my two cents which is probably worth far less than that. :lol: I'll be curious to see what your tests tonight reveal. I'll be up for a while yet tonight, and will keep an eye out for Ben's numbers.
 
Hi, Jenn. Thanks for looking at Ben's SS and giving me your insight.

I work 12 hour night shifts so I go to work about 5:45pm and get home at 6:30am. I can sometimes get away to check Ben's sugar around 10pm or 1am (+4 or +6) but not always. I am on an air medical transport team so it just depends on whether I am flying or not. I only work three nights a week however. (for the most part)

This week I work Tuesday, Wednesday and Thursday night. So it is your opinion that I increase the dose (maybe to 1.2U) but not until Friday when I can monitor him through out the night? Is night testing more important than daytime?

Thanks again for your help.
Lisa
 
Hi there! I don't know if night time testing is more important but it is maybe just as important? Sometimes kitties throw weird numbers at night. If you're getting wildly different AMPS and PMPS for example, seeing what cycle they run at night might give you a clue on how to get regulated. I used to try to get nighttime numbers when I could just to see if that gave any info I could use. At this stage, while trying to regulate, those numbers can help. :mrgreen:
 
Getting ready to do my AMPS and call this 24 hour curve done! Ben's been napping between checks but I am so ready for bed. Thanks for all the advice. I hope that you see something useful in the numbers. I'm planning on giving him 1U then tucking us both in for the day.
 
Jen is so good at non typical spreadsheets! Well, no lows overnight so I think a bounce is out of the question. That's good info to have and an increase looks like a good plan.

I like the idea of 1.2 for a few cycles. If you are home during the day this week, then I'd go ahead and up the dose and just check in early and then try to catch a nadir. I think night numbers are nice, but no more important than day. It's just good to get an occasional one so you see if something weird is happening overnight that you are missing. And a before bed (or work :-D ) test is a good one to have.

Does that sound doable?
 
Sue and Oliver (GA) said:
Jen is so good at non typical spreadsheets! Well, no lows overnight so I think a bounce is out of the question. That's good info to have and an increase looks like a good plan.

I like the idea of 1.2 for a few cycles. If you are home during the day this week, then I'd go ahead and up the dose and just check in early and then try to catch a nadir. I think night numbers are nice, but no more important than day. It's just good to get an occasional one so you see if something weird is happening overnight that you are missing. And a before bed (or work :-D ) test is a good one to have.

Does that sound doable?
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It is doable! I'll give him 1.2U this morning and check him when I get up in about 6 hours. Thanks again for the help.
 
Slept for 7 hours today to make up for yesterday. So the only test was at +7 and it was 220 which I feel was a nice drop. Not sure if it is nadir but on most curves his low is in the +6-8 mark. Maybe 1.2 U might be a good place to stay for a bit. SHH, don't tell Ben. He seems to hate having a plan. :-D
 
Dang it! Ben caught wind of the plan and his PMPS was 171. After stalling for 20", it went up to 189 so I gave him 1U. I have to work tonight so I will try to get home to check him but can't promose for sure. Guess I'll see how big the bounce is in the AM.
 
He is a sneaky little guy. :mrgreen: Maybe one unit at night and 1.2 in the daytime? Hope he doesn't bounce. I think you are on the right track - just need to see if he needs a constant dose or if the lower dose at night will work. Nice to see some yellow and blue!
 
Sue and Oliver (GA) said:
Nice to see some yellow and blue!
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Ben did not appreciate the yellows and blues. His body seems to say "Hey, we like all the extra sugar." His AMPS for 542 which I'm pretty sure is a bounce. Gave him 1.2U again. If his PMPS is in the blues what should I do? (although, knowing Ben, it won't be because I'd have a plan for that)

BTW, have I mentioned that I'm changing his name to Tigger because he likes to bounce so much? :roll:
 
Yep - not unexpected, but nice low last night - not too low so the dose looks right. He just has to get used to the blues, so then he can get used to greens. :mrgreen: Dose looks great this am. If he is at or near 200 tonight and sure rising, I'd go with the one unit again.


Lisa's Cassie was our previous Tigger. If you want to have Ben look good, check out the ss (her screenname is Bookworm)
 
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