? Dose increase & SRT consult prep

Madm4444

Madm4444

Member
Previous thread: https://felinediabetes.com/FDMB/threads/buster-dose-increase.298026/

@Suzanne & Darcy

Well, it figures. Just when we're seeing him turn a bit of a corner, we're going to mess it up.

Although the spreadsheet doesn’t really do it justice, he had a good night last night & good day today. 14u may not be the one that brings it into blues & greens but I feel like we're getting closer. He has been in the varying Libre 300s (with some mid to high Libre 200s) since yesterday morning (even overnight). He's interactive & moving around better.

Unfortunately, our SRT consult appt is Tues at 1115a. He cannot have any food after 10p on Monday night & we're supposed to give him 1/2 insulin dose Tues morning without food.

We have been moving his meal times so we can get to around 9p as his PM meal on Monday night. Hoping that will ease the fact that he will likely be without food for at least 16 hours.

Tonight will be the 6th cycle at 14u. Given the disruptions we know are coming, should we stay at this dose for a little longer? He may be higher than we like but it's the devil I know versus the unknown of 15u. What do you think?

Also, I'm really concerned about Tues after the procedure. He won't have had any of his Cerenia or Zofran & he'll be coming off the anesthesia. I'm hoping he's starving. @Wendy&Neko suggested bringing some food so he can have a little something. Since he will only have had 1/2 dose at 9a, would it be safe to move the time up to 7p for his full pm dose if he's okay to eat a little. And will we go back to the 14u & see where we are?

As you can tell, I am spiraling already... Any advice will be greatly appreciated.
 
Madm4444 said:
Since he will only have had 1/2 dose at 9a, would it be safe to move the time up to 7p for his full pm dose if he's okay to eat a little. And will we go back to the 14u & see where we are?
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I do think that — depending upon his numbers— you can consider doing this. If he is high you should be able to shoot early. We just need to see where he is. He could even surprise us with his numbers. Some cats drop low after stressful events and some go high. My own cat did this … sometimes low and sometimes high. Also anesthesia can definitely affect things differently.
 
Madm4444 said:
I don't have an exact time. The whole appt starts at 1115 so figure 1.5-2 hours for physical, bloodwork, etc. Maybe around 1-2p?
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I just want to make sure I am understanding. Tuesday is just a consultation. They will do general anesthesia for a CT Scan and/or MRI. This is in advance of the actual SRT appointment, correct?
 
It’s going to be okay. It really is. He still is running high and could probably do with an increase, but you’ve got to get him through this first phase so he can get treated. I don’t feel like this is the time to change anything until after the assessment is complete. Seeing how things go with the anesthesia for the assessment will be very helpful for you to prepare for the actual SRT treatment. It is going to be okay. You will take care of Buster and get him through this.
 
Suzanne & Darcy said:
It’s going to be okay. It really is. He still is running high and could probably do with an increase, but you’ve got to get him through this first phase so he can get treated. I don’t feel like this is the time to change anything until after the assessment is complete. Seeing how things go with the anesthesia for the assessment will be very helpful for you to prepare for the actual SRT treatment. It is going to be okay. You will take care of Buster and get him through this.
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Thank you. :bighug:
 
Beautiful! I love it. You certainly are kept on your toes. And all of this before tomorrow’s appointment. And I am sure you noticed he earned a reduction today.
 
Madm4444 said:
I didn't reduce since he'll be at 1/2 tomorrow. Should I have? Did I mess things up?

We also gave him a lot more food...
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As long as he didn’t drop too low last night it’s okay, right? I understand about the half dose. You have my good thoughts and some prayers for Buster today. Do they plan to tell you what they see today or will you have to wait?
 
Suzanne & Darcy said:
As long as he didn’t drop too low last night it’s okay, right? I understand about the half dose. You have my good thoughts and some prayers for Buster today. Do they plan to tell you what they see today or will you have to wait?
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No drop at all last night.
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Thank you for the thoughts & prayers.

I don't think we will know definitively today. But hopefully get an idea.
 

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Let us know how it goes today. I would go ahead and take the reduction on his next full dose. He has a way of going along and all of a sudden surprising us.
 
Suzanne & Darcy said:
Let us know how it goes today. I would go ahead and take the reduction on his next full dose. He has a way of going along and all of a sudden surprising us.
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@Sienne and Gabby (GA)
@Wendy&Neko

Everything went very well with Buster's SRT consult & CT scan. They have indicated that he is a candidate for the 3-day SRT treatment (early March being the earliest available appt).
As more questions came to us after we left (of course), we will be reaching out in the next day or so for answers. I will provide more detailed information here in the acro forum in the coming days.
Even though everything went about as well as it could, suffice it to say, I'm drained from the day.

However, I do need some help with tonight's dose, please.

Buster's dose last night was 14u at 9pm and he finished his last full meal (with extra) last night at 1030p.
He had 1/2 dose insulin this morning (7u) with a Churu tube. He also 'stole' 3 pill pockets that I had in my bag to take with us (yes, he was so hungry he tore the bag open with his teeth - he has never done that before - crazy).

I have updated his spreadsheet to the most current data from the Libre reader. It is on the way down now. It does not appear that he has hit his lowest yet.

We will be adjusting the timing of his shots over the next days to get back to 6a/6p.

Questions:
1 - How long after lowest (nadir?) do we have to wait to feed & shoot? Does it need to go all the way back up?
2 - If 180-200 is the lowest, what dose do you recommend?

Thank you for the help & support!!
 
So his shot was 9 p.m. last night. What time was his half dose this morning ? 9 a.m. ? What time are you shooting tonight? How many hours will there be between this morning’s dose and this evening’s?
 
Suzanne & Darcy said:
So his shot was 9 p.m. last night. What time was his half dose this morning ? 9 a.m. ? What time are you shooting tonight? How many hours will there be between this morning’s dose and this evening’s?
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Yes, 9pm last night & 9am this morning.

About 11.25 hours between shots if we shoot at 815p.
 
Depending upon his number, I would shoot at 8:30 instead of 8:15. Normally it’s best to adjust shot times by 30 minutes per day. If he’s back up pretty high by PMPS then 8:15 may be okay.
 
Suzanne & Darcy said:
Depending upon his number, I would shoot at 8:30 instead of 8:15. Normally it’s best to adjust shot times by 30 minutes per day. If he’s back up pretty high by PMPS then 8:15 may be okay.
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Since we have the Libre to alert us for anything low, should we stay at 14u or reduce?
 
Madm4444 said:
Since we have the Libre to alert us for anything low, should we stay at 14u or reduce?
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What is his number now. His new dose was 13 and not 14 because he earned a reduction from 14 down to 13. However, he still may be having influence on his BG from the anesthesia. I would like to know what he’s done the last few hours.
 
You’ve never shot blue before with a dose like this. If his PMPS is around 200 you could try the 13 units dose. If you wanted to continue with a slightly reduced dose just for tonight (maybe 10 units) to be on the safe side since a lot went on with Buster today, I would understand. If you feel very comfortable managing low numbers and will be available tonight to monitor the cycle and have high carb food and karo syrup or honey available— and he’s around 200 you could go ahead and try the 13 units.This is if he’s eating. Some of these dropping and low numbers can be from lack of food.
 
His numbers are probably dropping at least in part from lack of food. But make sure he’s eating while you shoot or just before.
 
Suzanne & Darcy said:
But you feel confident that he’s hungry now and will eat with his shot?
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Yes, he's been yelling at us to feed him for 2 hours. He would eat all night if we let him... :joyful:

Libre Bg 179. I shot 13u. I will have the reader in bed with me. The low glucose alarm is set at 70. But we know the Libre tends to be 'off' on lower numbers. Regardless, I feel okay that I can address it right away.

Thank you again. This day was tough & you kept me going. You are truly a blessing to us. :bighug:
 
High 300s all night. No drop. Do I go back to 14? 13.5?

Bg 348. Went with 13.5. We shall see...
 
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Suzanne & Darcy said:
Let us know how it goes today. I would go ahead and take the reduction on his next full dose. He has a way of going along and all of a sudden surprising us.
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I've been reading more about reductions on the ProZinc forum. I'm a bit confused. It says that if a reduction 'fails' (I presume no drop in bg), you should go to the previous 'good' dose. It also says that you do not have to hold the reduced dose. I took that to mean 1 cycle. Is that correct? That's why I increased Buster's reduced dose by 0.5u this morning.

Should I have stayed with 13u for another cycle?
If not, should I have gone back to the whole 14u b/c that was the dose that showed the most promising movement?
B/c he's acro, does that change the approach?

Told you I was confused... :confused:
 
Sorry I am just getting a chance to respond to this now. I would say that you can’t always tell if a reduction has failed with a single cycle. I would give it at least one day, two cycles.
 
Suzanne & Darcy said:
I would try the 13.5 tonight since he already had 13.5 this morning. He did have some yellows today.
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Whew. That's what I did. Can't believe I made the right decision!

Tomorrow will be 7am as we slowly make our way back to 6am/6pm.

In preparation for the morning shot, what numbers would you say trigger:
An increase?
A hold?
A reduction?

Thank you!
 
You asked me to take a look at his spreadsheet/dose. I would hold that dose right now. Look at those nice blues (with a 122 blue nadir -- so far anyway at the time I am looking at his spreadsheet.)
 
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