? DOSE! Please ADVISE ASAP

[Deena and Malby]

Hello,
Can anyone advise how much insulin to give Malachai right now? He's using a human meter.
19, 19.5 units, 20?
Yes I know I am missing a lot of data...

Thank you!

 

[Wendy&Neko]

I have no idea what to suggest for dose. Both of the dosing methods we use here decide on the dose based on how low a dose takes the cat. And that presumes we've been holding the given same dose enough to build a stable depot. You have one nadir of 93, which is a safe number, but the dose amount has been changing so the depot isn't stable. Sorry, I would only be guessing.

 

[Deena and Malby]

Last night (FB Acro group) I was advised to give the 19 units and then resume his normal dose if his numbers were back up this morning :/
I went with 20. Guess I just messed his depot up even more :/
Ill check him tonight around +7
So can you atleast advise what dose you think I should give him tmrw morning then if his numbers are "normal" for him (200's).
Should I stick with the 20 since that's what I just injected?
Thank you Wendy

 

[Wendy&Neko]

We dose based on the nadirs or low points. The preshot data is only a minor part of the decision. A dose somewhere around 21 has at least once gotten him into the 90's. Who knows if he's gone lower because of the missing data. Ask yourself, where do you want the nadirs to be. If he's new to seeing green (frankly, who knows), then he'll likely bounce and give you a higher preshot. You wouldn't change the dose based on that data point.

 

[Deena and Malby]

Blues are even new to me! But with that 120 yesterday, yes, I assumed he might have dipped in the green recently.
I'm comfortable seeing that 90 today but frankly anything much below that might freak me out.
I know we base dose changes off the nadirs but seeing that 159 last night for his PMPS, shouldn't I worry that he would dip into low numbers or no?
I know I am supposed to take the pre-shots to make sure it's safe to inject, but should I be more concerned with just the Nadir moving forward?
I was thinking maybe I should start doing .25dose increases and hold that for 3days. Thoughts? Would that be the best direction moving forward?
I'm usually great about holding doses for a while. In all honestly, I probably hold them for too long. It's only been recently that I've become more aggressive with his increases I don't know what to do with these new lower numbers.
Thanks again!

Deena

 

[Wendy&Neko]

I know we base dose changes off the nadirs but seeing that 159 last night for his PMPS, shouldn't I worry that he would dip into low numbers or no?

Lantus and Levemir are good at giving you flat cycles. Shooting low usually means a lot flatter cycle. But if you cannot or will not be able to monitor a cycle with a low preshot, it may be wise to wait until you can monitor before shooting lower. Doing a one time slightly smaller dose like you did last night will have hardly any impact. Most likely the 21 unit ish dose you've been shooting (not sure what 21.2 is on the SS) influenced last night's cycle.

At Malachai's size of dose, I wouldn't bother with 0.25 unit changes anymore. That's too small.

 

[Deena and Malby]

Hi Wendy,
Ok good to know that shooting lower usually means a flatter cycle.
The 21.2 was because I overdrew the insulin and didn't want to waste it so I figured I would just keep him at 21.2 for a few days and then move him up. But then he went low and I freaked out and reduced it...
Moving forward, since I decided on 20 units last night (which is also what someone over on the FB Acro page suggested to dose), I assumed I should keep him on this dose for a few days to normalize out his depot. Does that sound like a good or the right plan?
He was on 20 units from 4/25-5/1 and he never had any super low numbers. Given that info, and since you don't think I should mess with 1/4 increment increases, if his numbers go back up on 20units, what should I increase to? 20.5, 20.75 or back up to 21?
Also, I tested him at +8 last night and he was 228 so I don't think he goes lower at night.
Thankyou!

 

[JeffJ]

Hi Deena
The nadir tests are so important. I'm sorry to see that Malachai has gotten to such a high insulin demand. The current insulin levels look pretty good, but you have to ensure he is eating properly and you really have to test those nadirs each time. It can only be a single time for him to drop and hypo.

Some kittehs may go lower at night if they do not eat enough food. Some kittehs eat a lot, like Leo always has. I think many acro kittehs have a pretty big appetite.