Dose advice?

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monty_dweezil (GA)

monty_dweezil (GA)

Member Since 2014
I THOUGHT my fur son Dweezil's pattern was...

1. Nadir onset around 4-6 hours and lasting a few hours

2. Too many days of going into low green numbers which would then result in a dose decrease but also result in a few days of stubborn high numbers, either from bouncing or from the reduced dose not being sufficient

But right now we're just today seeing good numbers again, however his nadir is at 11 hours! It is one hour before his next shot and he's the lowest he's been all day! And yet most of his other nadirs are at 4-5 hours, though some have lasted up until his next shot time.

So my question is...

1.5 units seems to not be QUITE enough on a consistent basis

1.7 or 1.8 is good but also tends to result in going too low for too long if used on a consistent basis

When he is low at his next shot time, delaying by 30 minutes doesn't do much. He generally takes a few hours to get up to a shootable number. But with him, I don't want to skip the shot entirely as I know he will then be way high and hard to bring down for the next few days.

I suppose I could do a token dose like 0.5 or 1 unit, but in the recent past, doing this results in either him still going too low OR going too high.

HELP!!!
 
My first thought on seeing your SS is that Dweezil must be a very mellow cat to let you test so much! I thought I was a testaholic, but you have me beat! :joyful: Do you ever sleep???

I would say that Dweezil is breaking a bounce - this is the seventh cycle since his last greens, so that makes sense. Are you doing TR? Most experienced caregivers that have a lot of data will shoot anything over 50 on TR (on a human meter - 68 on a pet meter), and anything over 90 on SLGS. I normally would add here "if have supplies and can monitor", but you obviously can monitor.

Shooting low often results in a flatter cycle, and you need to try something to get these bounces under control.
 
Thank you!

He's actually right now on a continous monitor stuck to his back that I scan for readings. He does NOT allow normal testing unfortunately.

I fear shooting low in case it pushes him down even further. Like going from a high starting point down to low...surely going from a low starting point would be dangerous?
 
We have a saying here "shoot low to stay low". Usually (but not always - ECID), when you start with a lower number, the cycle will be flatter. Since your goal is normal numbers - 50-80 on a human meter - the sooner you can get comfortable with shooting lower numbers, the better. "Comfortable" is the operative word, of course.

monty_dweezil said:
He's actually right now on a continous monitor stuck to his back that I scan for readings
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How cool is that?! Is it a pet or human meter?
 
When a bounce is breaking, they will drop, unfortunately. I know you don't really want to skip, but if you decide to shoot a reduced dose, keep in mind that the depot will kick in and it will pretty much have the same effect as shooting the whole dose.
 
Hmmmmmmmm. THIS is why we can't get him stable, even with this amazing monitor. Because we can't shoot when it's 12-13 hours and he's 70 and dropping slightly.

They were going rabid before as it was after their dinner time, so I fed them and even 30 minutes after that, he's still slooooowly going down.
 
What about if I wait another 1-2 hours and then do a really small shot, like 0.5?

Hmm. Well, an hour later he has actually gone down a little bit lower. Despite having his dinner. No post-eating spike at all.

Is this a classic bounce? They go too low due to too high an insulin dose, then go too high and resist insulin for a few days and then go low again for aaaaages even with no more insulin given, due to the glucogen his body produced finally running out?

What on earth is his good dose then? Poor fluffsome! Lol.
 
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monty_dweezil said:
What about if I wait another 1-2 hours and then do a really small shot, like 0.5?
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It's better to either stall (without feeding) or do a BCS (one time reduced dose). Both will have an affect on the depot. If you shoot later, your shot schedule will be off by that many hours. You can slowly change your shot schedule back to regular time by 15 minutes per dose, or 30 minutes per day.
 
I see two 72s on the SS. He's holding stable. 72 is a very nice number.

As Dyana said, you're getting pretty far off schedule. You could do a 18/18 if you wanted - so the next shot would be 18 hours after your last one, then the next 18 hours after that. That will put you back on schedule at your regular shot time and drain the depot some. Some people like it better than skipping and letting the cat go 24 hours between shots.
 
monty_dweezil said:
Is this a classic bounce?
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Sort of. Some cats, depending what their numbers are, will bounce if they see blue (or even yellow).
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
You could try keeping him from going so low with a bit of food and try and even out the entire cycle.

:bighug:

Frustrating I know. Gizmo saw 80's last night and his +11 was 182 :banghead:
 
Thank you so much for all your help!

My issue with shooting even a reduced dose at his normal time was that even after eating, his glucose was dropping and food did nothing (and usually does nothing, even mc food) to raise it.

He has since had 2 dinners of sorts and his BG is only now just starting to come up, 4 hours after his 12 hour dose.

So...if I wait another 2 hours to make it 18 hours, that will be 11pm-ish (I'm up until after midnight mostly and my partner gets up at 5.30am). Then another 18 hours after that would be 5pm, which is his normal time. That sounds good!!!!
 
Ok, so I just gave Dweezy 1 unit at 18 hours. He was at 234 by that time. Fingers crossed he doesn't go too low later in the night or skyrocket tomorrow during the day.
 
For those interested, here is a pic of Dwee showing his sensor.
IMG_20170816_002210.jpg
 
Could you modify your spreadsheet a bit to show the 1.0 unit given at +18. In the PM+6 cycle, you would write "234 1.0U @+18". Not everyone reads the Remarks, and that would give us a quick hint that you've done the 18 hours. Then when you shoot tomorrow at PM, write <PMPS number? @ +18.

By the way, Lantus really does better with consistent dosing. He will be higher because of the 18 hours dosing since it disrupts the depot, but my suggestion is to go to 1.5 units, and hold that same dose for at least 6 cycles for the depot to stabilize. Try to ignore the high preshots for that time period. Of course, if he earns a reduction you would go lower. But for now, with all the dose changes it's really hard to figure out what a good dose is.
 
This is really frustrating because we had tried to hold the 1.5 dose previously but he kept going low so we had to reduce. See all those greens last week? Then also on 1.5 he has been consistently too high, so we fear ketones by ignoring it and not increasing the dose just a bit to bring the numbers down.

He actually had DKA twice, once in May and then again in July (both times caused by needing extra insulin while away in the cattery but nobody knowing so he was going so high and his normal 2 units then wasn't working at all. Both times he was doing great before, and then within 5-7 days, DKA occurred and he showed no signs of illness and no urine ketones until literally he was in desperate trouble.)
 
Having said that, it seems I may as well have not given that 11pm dose at all as he is now 430 and after he finally began to rise a little bit at +5 hours and I gave him the smaller dose, he just kept going up and that dose did nothing. Sigh. The only reason I gave that dose was too avoid this very thing happening by not having him go the whole 12 hours without a dose.

I am upset now as he was doing SO well yesterday after days of being too high (after going too low before) but I simply cannot give more insulin to a cat who at +12 hours is at 72 and falling! And who at +13 hours is still under 72 after not eating and who then and shortly thereafter despite having eaten is still falling! And even at +14 had only just started to go up to a level that many people still wouldn't shoot.

I thought doing a +6 shot and the 18 / 18 thing would be the best option, but clearly not. I don't know what the best option should have been though. Maybe there simply wasn't one.

I feel like with this monitor, we should be able to regulate him easily with so much data, but still no because whenever he gets into good numbers, he ends up going SO low and for SO long. Yesterday I really thought his nadir was at 3pm (+9 hours, which is 5 hours later than normal for him anyway) and was so pleased as it wasn't for once hypo-low. But then the true nadir didn't emerge until +12-14. How on earth would anyone expect this?

This happened a few times at the cattery near the end of the trip, and at his next shot time he was still hypo-low but he got his shot anyway (dose reduced from 3 units to 2.5) and was then monitored closely, and everyone was then baffled that his glucose shot straight up after that, and didn't go further down.

So shooting low to stay low didn't work in that case. I presume since he was low and then got more insulin that he did a major bounce. But then last night when I didn't give more insulin when he was low, he still bounced way high!

AAAAAAAGH!!!!!!

Ok, vent and rant over.
 
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Hi, Dweezil is just bouncing from the low numbers yesterday. His body isn't used to lows so it's normal to bounce. If you go through others posts you will see a lot of bouncy kitties, especially one newly diagnosed, but even some long timers still like to keep there bean on their toes and will throw a bounce once in a while. He will stabilize, that is also a reason to try and find a dose you can shoot each time. You will get there.... when bouncing you just need to wait till the bounce break and you should see better numbers. Can take up to 6 cycles depending on the kitty. Last time dweezil had a bounce it lasted 6 cycles, the other times were a bit shorter. Even Though it those nice green numbers we want, when we first get them they scare us too. It's all normal. You are doing great.
 
monty_dweezil said:
This is really frustrating because we had tried to hold the 1.5 dose previously but he kept going low so we had to reduce. See all those greens last week?
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I don't see him getting a 1.5 dose last week. I see him going green on 3.0 units and the 3.0 unit depot. The 10th is when you started giving him 1.5 units, but not consistently. You were giving 1.0 unit in the mornings. Consistent dosing is key.

Sometimes the 18 hour thing doesn't work - it was an experiment. Sometimes it's better to just skip a dose instread of having two longer cycles. Having said that, I once tried 18 hour cycles with Neko, and it worked very well for her. ECID - each cat is different.

Take a break, do something for yourself today. :bighug: And test for ketones.
 
monty_dweezil said:
This happened a few times at the cattery near the end of the trip, and at his next shot time he was still hypo-low but he got his shot anyway (dose reduced from 3 units to 2.5) and was then monitored closely, and everyone was then baffled that his glucose shot straight up after that, and didn't go further down.

So shooting low to stay low didn't work in that case. I presume since he was low and then got more insulin that he did a major bounce. But then last night when I didn't give more insulin when he was low, he still bounced way high!
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Lantus is a depo insulin so it doesn't work like the In and out insulin. It's long lasting, so giving additional shots will not work, but will mess up the depo, and could cause issues later in the cycle. Avoiding bounces is hard, small meals through out the day helps, trying to slow down those the lows as it is lowering with food I hear helps, but ECID, some cats are just bouncy, some cats stop bouncing or clears the bounce faster once they get used to lower than normal numbers. The most important right now is to find a dose you can shot 2x a day, and are able to hold for a few days. I am still new, the fold here that have been here a while are excellent and have good experience. They will guide you and answer any question you have. Keep positive, it does take time.
 
I completely get that, I was at that same play in April. Am so thankful to have found this place. All the information and feedback was overwhelming at times, but once I started changing one thing at a time and seeing the difference I started understanding the guidelines better as I was seeing the results myself on my kitty.

:bighug: you need it today
 
See, today Dweezy's numbers are much better but I'm now worried he'll dip low overnight. He had 1.5 units tonight.

And the real issue of frustration is that tomorrow, we must be out at 10.30am and won't be home until around 4pm. So due to this and if Dwee goes low tonight, his morning dose will need to be reduced. Which will then result in another day or so of high numbers.

How on earth do you keep a dose stable when circumstances change and when a cat is prone to either going too low AND too high?
 
You do the best you can. Safety is always key. If you can shoot full dose that is great, if you are not comfortable this time than you can adjust.

Some people leave food out, others have an auto feeder and schedule it for the times bg normally move down. Since you have the best data we have seen, you can probably tell the pattern of when he would need to be feed to ensure he surfs.

If the food is not an option, then if it was me I would post in the morning with his BG maybe 30 minutes prior to your shot time.

You have a lot of data, and from what I can tell dweezil behaves almost text book to Lantus. When he had those greens, his +2 was either equal or lower than his pre-shot number. So his + 2 is a good indicator if he will have an action cycle. His lowest point during the day seems to between +6 to +8.

I think that at the beginning his dos was too high, which is probably what was scary. I think you are getting close to a dose you can shot twice a day, it will be easier once that happen to manage when you are not available to monitor. Remember dose is based on nadir, how low the dose is taking him, it is not base on the higher numbers. eventually as he heals those high numbers will come down too so that you can have a nice flat cycle in the greens (and probably some nice blues).
 
Thank you so much for that advice. It really helps.

Dweezil this morning scratched off his monitor so sadly, I now once again feel like I'm walking around a minefield blindfolded.
 
The problem I also see from the data is he has tended to go down to 2.2 for quite some time and/or gone slowly down to his lowest point between +10 and +14. But not always.

Right now for instance, when he knocked his monitor off this morning he was at 162 which is great, but what happened after? We have no idea if he bounced up to 360 or kept going down to 36.

He also tends to only eat when directly given food. Once we leave or he walks off from food, unfinished, we notice he never returns to it until we get back. He won't just eat by himself so leaving food out is good and I've always done this, but he doesn't usually eat it while we're out.
 
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Bummer that he scratched his meter off. I had been wondering if that could happen. I'm sorry I got my answer! Do you have to go to the vet to get it reattached, or can you do it yourself?

Monty, I know you are frustrated with the bouncing, and having to sometimes skip shots further muddies the water, but you are really doing a great job. Hang in there!

I do have a request: tomorrow morning (Saturday), could you please start a new thread? We ask each member to do a new "condo" each day, with a link in the first post to the last condo. Otherwise, a condo gets way too long and it's hard to follow. If you don't know how to create the link, just ask.
 
OH! I didn't realise I was supposed to start a new thread each day! Sorry about that!! :)

Unfortunately, we can't re-attach the monitor as a whole new one must be put on from our vet. The problem is, it's really only meant to be worn for 2 weeks occasionally, not for weeks or months on end. The cats can technically remove them but only usually towards the end of the 2 week sensor lifespan when the adhesive wears out anyway.

I feel like an addict, like begging the vet "Just one more sensor! I know we shouldn't, but just ONE more! PLEASE!" Lol.
 
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