Decrease dose?

Hey guys, Ive been seeing Harrison's numbers going really low. 2.8 today, is that too low? Is this a good thing ?
What are good numbers? And when should I not give insulin? Also should I go back to 1.5u insulin for tonight

 

@JanetNJ

@Panic

Thank you ladies

 

Can you get another test right now please?
2.8 is far too low when using Caninsulin. If Harrison is below 3.3 (60), you will need to take immediate action.
Do you have high carb food in the house? Honey? Maple syrup? Corn syrup?

• How to treat HYPOS - THEY CAN KILL! Print this Out!!

 

I cannot stay with you.
Tagging @tiffmaxee
@Diane Tyler's Mom

 

You need to feed some high carb food and retest in 20 minutes. A reduction has been earned. I’m not knowledgeable on dosing for your insulin so someone who is will tell you how much of a reduction to take later.

 

Oh gosh he didnt have symptoms and did 3 tests. Am giving him chicken in gravy now. I feel horrible, Should I give him 1.5 tonight ?

 

Thanks. I am giving him chicken in gravy now.

 

Post your next test result please when you get it.

 

I got 2.9 ten mins ago and hes eating chicken in gravy now.

 

And I just gave him

a few licks of syrup.

 

Test 20 minutes after he ate. If he’s still dropping you might need to put syrup on his gums. Is he not wanting to eat? A teaspoon or two each test with gravy should be enough. The carbs are in the gravy.

 

Good he’s over 50 but he needs to be higher.

 

Yah. The numbers went up slightly. Gonna check again in a few.

 

Meter variance is 20% so not up really.

 

Okay 6.2 now

 

So going forward he earned a reduction. The shot will be 1.75 now.

 

My needles only do .5 lines. Can I just go back to 1.5u

 

you can just eyeball it and go between the 1.5 and the 2. None of the syringes have quarter markings. You can try 1.5 but he may run a little higher.

 

Hi Heather,

For future reference, if Harrison drops below 5.0/90 on a human meter, the FDMB Vetsulin guide indicates the dose should be immediately reduced by 0.25IU starting with the very next dose.

You're doing a grand job with the testing. To help you get more benefit from the info on the spreadsheet, have a look at the way your preshot tests were moving into the yellows over the last few days. Keep an eye on trends like that because they may indicate that the dose needs to be looked at, as indeed has proved the case. Last night's mid-cycle 3.3 reading was a signal to reduce the dose.

Great job catching the low nadir today.


Mogs
.

 

Thank you so very much. I will try this going forward.

 

Thank you for this info. I didnt realize last night but knew I was going to make a post seeing the trends. Lower that 5.0 means reduce .25u. Is there a lowest PS number that ill reduce and or not give insulin? Or is that the same question. I mean will test during the cycle only tell me to reduce or PS tests?

 

At the simplest:

* the preshot tests will tell you whether or not Harrison's BG is high enough to give the next dose of insulin.

* the mid-cycle tests will tell you how low each dose takes him, and can also give information on dose duration.

For cats with limited data, the recommendation is to set 200 (human meter) as a 'no shoot' limit. (NB: For cats with a history of ketosis or DKA it's not advisable to skip doses so, depending on the size of the regular dose, a reduced or token dose should be considered. If on a very low dose, post to ask for suggestions as to how to proceed.)

In case you've not found it yet, here's a link to the FDMB Caninsulin Guide.

For cats with less than 3 months' worth of data, if a preshot BG is under 200 the guideline is to stall without feeding and then recheck BG in 20-30 minutes to see whether it has risen high enough to give the dose. (Tip: While waiting to do the next test, post for help, including the phrase 'STALLING - Need Help' somewhere in the title.) See the Caninsulin guide for further info.

When it comes to dose adjustment, both increases and reductions are driven by the nadirs. From the Guide:

The general guidelines for making dose changes are:

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
• HOWEVER, there are some situations which signal that a larger than usual dose reduction is needed. If you are unsure, please post on this forum or in the Health forum and ask for input about your dose.

As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], lengthen the waiting time between dose increases. If you decide to change another factor (e.g. diet or other medications), don't increase the insulin dose until the other change is complete but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change.​

As always, please post for help and advice any time you need it or with any questions you have. And maybe post some more piccies of that incredibly handsome boy of yours!


Mogs
.

 

Agree with Mogs - to add to that, make sure you are testing, feeding, waiting 20-30 minutes, and THEN giving Caninsulin. Another snack of their regular food every hour (plus a test after an hour) will help keep Harrison safe. If you see noticeable drops within the first two hours, that's a strong indication to keep an eye on his BG.

I see you're in Canada - has anyone mentioned switching Harrison to Lantus insulin? It is much gentler than Caninsulin, which is designed for dogs.

 

Thank you very much for this info.

 

I do the test, feed and wait 30 minutes every time.
And yes I have asked about another insulin, my vet told me to wait another week. But then his numbers dropped.

 

Great! Wanted to make sure you knew.

 

Thank you all so so so much ❤

 

his pmps is lowest I've seen too. Should I give him 1.75 ? Or less now ?

 

Stall feeding for 20 minutes if you haven't already fed him and see if he goes over 200. Think that's 11 for you.

 

Oh shoot. I did feed him but he didnt eat the whole thing. He did have a good snack today.
Ill test him 20 minutes from now. But if he doesnt go over 200 then no insulin?

 

His BG will rise since you fed him, just remember next time to stall feeding. This time I would either skip or do a token dose of about 0.25 units since you're not sure. He DOES seem to be on his way up though. Decision is yours.

 

Hes 11.7 now. So it seems he is on his way back up. So i am going to token dose of .25 and keep monitoring him.

Thanks everyone for your help.

 

Skip or .25u this time. Food raises BG so part of that number is from his meal - you base dosing on fasting numbers, which is why we say to stall if it's not high enough, to see if it will go up on its own without food bumping it up.

 

If you do give a token dose, Heather, I'd suggest doing your first mid-cycle test by +2 latest (to help gauge how the drop is going and intervene with food if necessary). If Harrison starts looking for food sooner than that, test him then, don't wait till +2, then let the BG numbers guide when to test next (and post for help if you need it!). I'd also suggest getting your PM+4 test in to see where he's at while the dose is exerting its greatest effect. If it does take him fairly low I'd suggest keeping an eye on BG level till you see it rising without any help from food.


Mogs
.

 

So if I understand correctly, tomorrow morning when I PS. If he is over 200 then should I give him 1.75u? And if he is below 200 I should stall with out feeding and test again in 20-30 mins? And if after the stall he is on his way up do I token dose again?

I guess as he gets used to the insulin and the low carb food. Is my goal is to find the right dose so he doesn't get dangerously low and the daily curve is consistent? Or will I always have to judge his dose based on his BG numbers?

 

Oh and you guys wanted some pictures so here ya go! http://imgur.com/gallery/ZhDrDl5

 

If you can monitor through the cycle, yes. At the rate Harrison has been improving over the past few days, keeping a very close eye on things is wise.

If you're not able to monitor, I'd suggest dropping the dose down further. Post for help at preshot time if you're not sure what to do. It's sometimes an idea to get a +11.5 test as well as the PS test. The earlier test might give a hint at where numbers might be heading and it would give you that extra 30 minutes to post here for suggestions on how to proceed.

Love the pics! Harrison really is a magnificent cat.


Mogs
.

 

Hey so this morning we dosed at 1.75u and he dropped really low. I panicked a bit and i think i over fed him with chicken and gravy x2 and some maple syrup.

Now his pmps was 17.6/317.
What do we dose for in 30mins

Thanks

 

Hi! Good catch! So he earned another reduction. Try1.5. May be a little high a couple cycles with a bounce from the low.

 

Yep thats what we just did. Thank you so much!

He has been so playful lately too. I think he is feeling better

 

That's great!