Dose advice

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AbyResq

AbyResq

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Hi, I'm a new member. I had a thread in the general health forum last week. It looked like Tuck might've been going into remission. Then I accidentally didn't get a closet door latched securely and Tuck gorged himself on grain based dry food. So I put him back on insulin to deal with the high blood sugars.

Now, I feel like I can't even get him regulated. Can someone look at his spreadsheet and give me your thoughts. I tried reducing him from 1 unit down to .5 yesterday but that didn't seem to work - I thought maybe he was bouncing. I put him back on 1 unit last night and this afternoon's +6 reading was 55. The big swings have me confused if I should stay the course or make an adjustment.

Also, he needs a dental. He had a shot of convenia about 3 weeks ago. I'm wondering if his new pattern is a sign that antibiotics were helping him before and I need to start him on another course. I have Doxycycline at home and plan to start him on it tonight to see what happens. I'm at the vet on Friday with 3 other cats so I will discuss all of this with her then.
 
It looks to me like one unit is too much. Yesterday your 65 was a nice nadir, but he might have been lower (and too low ) earlier. (BTW, what kind of meter are you using? If human, 5o is the number edging hypo territory and the signal to lower the dose. If a pet meter, it's 68.). The 0.5 unit for the 189 also looks like too much as you got an unshootable pre shot this morning.

If he were mine, I think I'd stick with 0.5 if you get a preshot in the 300s - which you may get tonight as you skipped this morning. And if he has a lower preshot 200 or below, maybe pull up 0.5 and let out 3 drops or so. (Or try to eyeball 0.25). I would skip under 200.

I do think his changes are good for remission(anti jinx). If he has had an infection, that could have raised his blood glucose levels and he is body may be adjusting downward as he heals. He is on a tiny dose and is doing very well.

Have you seen the protocol we put together for ProZinc? It is in my signature.
 
@Sue and Oliver (GA), argh something wasn't right with the link to the spreadsheet in my signature. Your comments weren't lining up with my recent results. I shot him this morning. Can you try looking again, I think it's fixed now.

I am using a human meter, One Touch Ultra. I read the protocol. I feel like I have days where the Nadir suggests that 1 is too much and then there are the other days.
 
It says I need permission. Go back to your original. Choose Share in the upper right hand corner and then choose Share with "Anyone with the link"
 
Ok. Got it. So the one unit on 336 gave you a 55 - that's a trigger that the dose on that range needs lowering. But the 0.5 on the 321 is puzzling. If he bounced up to the black, you'd think we'd see a lower number than 222.. It might have been lower before or after, I guess, and caused a bounce.

I think we work with what we know. The one unit on the 336 was too much because you got the 55. So he may bounce for the preshot tonight. Even with a black, I think I'd stick with one unit. Then if tomorrow you get something in the 300 range, give 0.5

With ProZinc, you can use a sliding scale. It works well for some cats, not so great for others. But I'd try it. So a smaller dose for a lower preshot and a little more for a higher one. See what that does, get one or more tests during that 5-7 range when you can, and we go from there.
 
At PMPS he was 431 and 1 unit gave me a 58 at +4. I let him eat a can and a half of Fancy Feast and retested at +5 and he was 101. I decided to not overload him on carbs at +4 and see if the FF would bring it up or not. I was watching him and if he became symptomatic of going too low I would have treated him. If he'd still been borderline low at +5 I would've given him some dry food. He'd had a similar pattern on the night of 3/20 and I felt like I'd overloaded him on carbs that night. Readings in the 50's concern me especially at night and when it's before the insulin should be peaking.

This morning he was 318 at his preshot and I cut him back to half a unit. Hoping he doesn't go to the high extreme like he did the other day.

I'm going away for 4 days the first week of April. A vet tech is coming in twice a day to care for my tribe. I'm trying to find a consistent dose for him even if he'll have to ride a little high. The vet tech won't be here when his insulin peaks so these 50 numbers seem too low for comfort.
 
I completely agree with your thinking, Abby.

It's a great idea to try the regular wet first when they start to slide into the 50s. Often that is enough to slow the trend. The other weapon in your hypo kit can be gravy FF. Just a teaspoon or two of the gravy can be enough to bring them out of the lower 50s.

It will be interesting to see what the 0.5 does; I like it. You have a amps that is 100 points lower than yesterday so logically the nadir should be influenced by less insulin. Course, cats aren't logical..... We can talk about a fat or skinny 0.5 if that would be a good option. The other choice, if you find you need to be giving small doses, is using U100 needles and the conversion chart. You can give 0.1/0.2/0.3 units etc.
 
Well .5 got him to 83 at +4 and 56 at +5. I fed him a can of Fancy Feast at +5. Will test again at +6 to make sure he's stable or rising.

I'm starting to think his nadir is around +5. I'm hoping these results are again an indication that he will go off insulin. He was off for a few doses last week then he got into a bag of dry food. Maybe he's just been yo-yoing as a reaction to too much insulin when I restarted him. If he's anywhere in the 200's at PMPS I may try skipping tonight's dose to see what happens.
 
This is a beautiful curve, as long as you are around to feed him a little and stop the downward movement. As long as you are there, this dose looks perfect for the pinks. If he is closer to 200 tonight, rather than skipping, I'd consider eyeballing 0.25 or pull up 0.5 and let out a couple drops.

His pink preshots say to me that he still needs insulin, but he is definitely gradually needing less. The trick at this point is to give him just enough to keep him in healing ranges but not too low. He is looking good, and yes, I'd think your chances for remission are good (anti jinx) is
 
So he's at 160, this is when I should be feeding him and giving him insulin. Guess I should wait about 30 minutes to see if he becomes shootable?
 
Yes, see if you can wait 30 minutes without feeding and if he rises, at least to 180, and then give a few drops? If he continues to fall, your choices are to skip or to feed him, wait 2 hours and then give him a dose, knowing that the next shot will be off schedule by 2 hours.

Looks like he wants off insulin!
 
He dropped to 151 which basically means he was holding steady. I think I'm going to skip shooting him tonight and see where he is in the morning. Curiosity will probably make me check him before I go to bed.
 
Still fiddling. His +3 last night with no shot went up to 384. Clearly that indicates he still needs insulin to cover his food. He had fallen to 230 by AMPS so I tried to guesstimate a dose lower than 1/2 unit. I do think he's gradually coming off and I will need to give him tiny doses for a few days.
 
Last night at PMPS he was 159 and I debated what to do. I decided to give him a tiny dose, eyeballing something under 1/4 unit. He did really well.

This morning he was at 114 so I decided to try skipping his dose. No insulin, 2 hours after breakfast he was at 196. I debated shooting a 1/4 unit or waiting to see what his blood sugar would do. Well at 4 hours after breakfast he's risen to 448.

I want to maximize his chances of getting off insulin. With this pattern, I feel like it might be safe to try giving him a tiny 1/4 (or less) unit whenever he's 160+, assuming I'm here to monitor. Looks like I might be better off giving him a meal and waiting 2 hours before I shoot him.
 
One way people deal with cats going OTJ is to chase the number. So you decide on a number you are willing to shoot - I think your 160 is fine, as long as you can monitor- and shoot when he reaches that. It needs to be near +12 between shots and is likely to be off the 12/12 schedule completely - maybe +14 one cycle, +16 the next. It means being around to test until he reaches your target and being willing to shoot at odd times. But it's a way to have him stay in good numbers consistently.

You might see if you can get a few U100 needles from the drug store and have them available to shoot 0.1/0.2 when you want, using the conversion chart. Be sure to get ones with 0.5 markings.
 
Thanks again. Since I'm leaving for 4 days week after next, it's worth it to me to try chasing the number for the next week. I'm paranoid about the cat sitter giving him insulin when I'm gone. Maybe if I chase it we can try letting him be off insulin for the days I'm gone. I can have her test and if he is rising too much I can instruct her to give him small doses. I got so excited this morning and truly wasn't expecting that much of a rise 4 hours later. More work to do....
 
It would be nice if they would just go off insulin, but it is most often stops and starts. The most likely reason that his numbers continue to be lower after 12 hours is that his pancreas "wakes up" and helps out. But then it rests and his number rise because the insulin is gone. So, the idea is to support the pancreas while it is trying to work with small frequent meals and small doses as needed.

You are doing great. Paws crossed that his pancreas decides to join the party completely before you have to leave town.
 
Just doing a little happy dance because no one in my day to day life gets why I'm excited. He woke up in the blue and I decided not to shoot. He's been in the blue all day. I tried this a few days ago and it didn't work but today he's nice and steady!!! :joyful: I bounced him yesterday and didn't want a repeat.
 
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