? Dosing advice - BG has been high; changed dosage

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shelaghc

shelaghc

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For the last ten days Jester's BG has been fairly high, with the exception of two cycles when he ate substantially less than he usually does.

Today, I decided to try upping his dosage to 1.25U (at least that's what I eyeballed it as).

I've been advised in the past that the general rule of thumb is to keep dosage changes for three cycles and do mid-cycle tests. In this case, Jester's AMPS was 361 and his mid-cycle (fasting) BG at+6 was 113.

If by chance his BG happens to be in the mid-to high-100s, should I still follow the three cycle rule or go back to 1U?

Or if he's below mid-100s should I give him even less - .5U or .75U?

I'm trying to anticipate possible issues rather than wait until his PMPS when getting dosage advice will be more time-critical.

As of now, I'll be checking his BG around 9:00PM for his PMPS and evening dose.

Thanks very much.
 
shelaghc said:
the general rule of thumb is to keep dosage changes for three cycles and do mid-cycle tests.
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After three cycles you would only increase the dose if the BG data (including midcycle) is showing the dose to be too low - nadir values in the high blues or above (roughly). If the nadir is too low in any one cycle you'd reduce immediately. The reason for the 3 cycle guideline is to give enough time for the kitty's body to adjust to the dose. If a dose is producing good nadir values (roughly high double digits to low 100s) you keep the dose beyond three cycles.

The general guideline for desirable BG levels is:
  • pre shots in the low to mid 200s
  • nadirs in the high double digits to low 100s.
It's quite common with in and out insulins for pre shot numbers to take longer to come down than nadir numbers - ie., nadirs might be in a good range while pre shots are still high-ish. That's why a dose can only be properly assessed by looking at both PSs and nadirs.
 
I've already increased his dose because of the high numbers. Are you saying I shouldn't have?
 
Also, I'm not asking about increasing the dosage.

Since I already did, I'm asking about what I should do depending upon what his BG is for his PMPS.
 
shelaghc said:
I've already increased his dose because of the high numbers. Are you saying I shouldn't have?
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No, I was just summarizing the decision-making process. Based on the nadir BG today at a dose of 1.25 u he's OK. What I would suggest, though, is to do dose changes only after you've been able to get mid cycle data the day before. Otherwise you're essentially changing it blind. Knowing how low a dose is taking him is important. I know you have to ration your test strip use so that means you might have to hold a dose longer.
 
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shelaghc said:
Also, I'm not asking about increasing the dosage.

Since I already did, I'm asking about what I should do depending upon what his BG is for his PMPS.
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If PMPS is in the range of today's AMPS and taking into account the nadir you can likely keep the 1.25 u dose. However, he's had some strong responses to the smaller 1 u dose so it's hard to be definite with any advice. It might be a safer bet to leave him at 1 u.
 
I think the 1.25u looked good today. Hopefully he'll give you a PMPS that will let you hold it. If his PMPS is much below 200 though, you might want to drop back to 1u just because you've mentioned in the past that you need to limit the mid-cycle testing a bit.
 
Djamila said:
I think the 1.25u looked good today. Hopefully he'll give you a PMPS that will let you hold it. If his PMPS is much below 200 though, you might want to drop back to 1u just because you've mentioned in the past that you need to limit the mid-cycle testing a bit.
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Kris & Teasel said:
No, I was just summarizing the decision-making process. Based on the nadir BG today at a dose of 1.25 u he's OK. What I would suggest, though, is to do dose changes only after you've been able to get mid cycle data the day before. Otherwise you're essentially changing it blind. knowing how low a dose is taking him is important. I know you have to ration your test strip use so that means you might have to hold a dose longer.
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For a change, I'm doing okay on supplies. Got a couple of Amazon GCs that helped a lot and have a decent supply of supplies. ;->
I'm planning to check his BG around the four hour mark tonight after his second dose.

These are both very helpful.

Thank you both very much.
 
Hang in there! :bighug: For most cats, the pre-shot numbers are the last thing to start to come down. But the more time Jester spends in good numbers in the middle of the cycle though, the better. He'll get there!
 
Pre-bed BG is 341, not fasting - but he didn't eat all that much.
I would speculate not more than 1/4 can of food, and most of that was a low carb pate.
Plus it's been about an hour since he ate.
 
During the mid-cycle tests we don't worry too much about if they have eaten or not as long as it's their normal routine. Grrrr on the higher number though. Hopefully he'll have a better cycle today.
 
And he did - 279 this morning!
Crossing fingers that it's not a fluke.
Djamila said:
During the mid-cycle tests we don't worry too much about if they have eaten or not as long as it's their normal routine.
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Jester doesn't have what one might call a normal routine right now. Generally he lets me know when he's hungry and, depending on what's going on, I go out to the kitchen with him. It's the closest to his old grazing he can get. (I've been trying to change him to a meal kitty for over three years because of my middle kitty Bastian who tended to eat everything in sight and gained a lot of weight as a result.....)

Should be challenging next week. I may be starting a part time temp job - four hours a day, five days a week with about an hour public trans commute each way.
Jester's going to be one frustrated kitty.
 
Are Jester and Bastian bonded, or can you separate them? Maybe when you leave you can put one in a bedroom and let the other have the house, then switch every few days so Jester can have food while you're gone?

Congrats on the temp job!
 
Djamila said:
Are Jester and Bastian bonded, or can you separate them? Maybe when you leave you can put one in a bedroom and let the other have the house, then switch every few days so Jester can have food while you're gone?
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Not really bonded, no. But I have a third cat - Sage - who will eat everything out from under the other two. *g*

The setup in my apartment really doesn't allow for keeping one cat in one room. Plus, if I do anything like that with Jester, he will shred the carpet by the door trying to get out. Trust me - he's done it. (Or on the rare occasions when I've shut the kids out of the bedroom trying to get sleep when they're being rambunctious, Jester will shred the carpet to get in.)

Djamila said:
Congrats on the temp job!
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Thanks - still waiting to hear from the temp agency. It's not an ideal kind of assignment - call center - but hopefully I can handle it for the six weeks involved. (I have physical challenges.)
 
Mid-cycle BG (fasting) was 101.

And that's what happens when I increase his dosage. Took 3 cycles this time, but it dropped like a rock.

And if I'm going to be out for six hours a day five days a week with no availability for Jester to eat during that time, it's likely I can't give him more than 1U no matter what - even if his BG is in the pink numbers.
 
101 is still a very safe number. On a human meter she can go all the way down to 50 and still be safe. I think for now this is still a safe dose for him. You can keep an eye on his responses during the evening cycles if you're at work during the day, so you'll know when he's ready for a reduction.
 
Considering he mostly ate shreds (medium carb) earlier today and less than half a can of pate (low carb), the drop is actually pretty significant.

However, I'm going to stay cool and patient. Tonight he likely won't get insulin until around 9:00PM or later. But during the week I need to start adjusting his dosage time to more closely match when I'll be leaving to catch the bus. (Still not sure if I'll be starting next Monday or in two weeks.)

To be safe, I'm going to start making myself get up earlier and move his time back in about fifteen minute increments. By next Monday he should be getting insulin no later than 8:00AM since the bus leaves at about 9:00AM. (I *hate* getting up early. *g*)
 
This is where it gets a little nerve-wracking.
Jester isn't the greatest about eating right when I need to give him his insulin. If I were to wait until he actually eats what some might refer to as a "full meal" to actually give him the dose, it might not happen until 2:00 in the morning.

His PMPS was down to 210 but it's doubtful he's even eaten more than 1/8 of a can of food during and since his insulin.

If I'm lucky, I'll get more into him before bed. And, tbh, I generally am able to.

But prior to the 2-hour cutoff before that testing, he hadn't eaten much and I was nudging him a lot to eat. I hate having to make him wait to eat and he usually will fuss to eat at least an hour before his PMPS.
 
He doesn't need to eat a full meal right at shot time. He just has to eat enough so you know he hasn't gone off his food. Sam usually just eats about a tablespoon at shot time, and then comes back and snacks for the next few hours. If a cat is sick they will sometimes refuse to eat, and if they are refusing to eat and go low, you could be in for trouble -- that's why eating is part of the test/feed/shoot routine - it's just to make sure they are okay - like checking the safety systems in an airplane before you take off.
 
He's cuddled in my lap right now. I expect when I need to move (cramp in my back right now), he'll head with me to the kitchen.
If need be, I'll open a new can of his medium carb food. That usually catches his interest.
 
+4 was 196 after eating some carby stuff.
I also gave him a Pepcid. I think he's been having morning foamy vomit - although by the time I get up it's mostly absorbed by the carpet.

If his appetite is improved tomorrow, I'll give him some for a few more days and see how that works out.
 
The foamy puke is often a sign that they need a snack. I know that's tough with kitty thieves around and the middle of the night and all -- but it's the most likely fix for the vomiting.
 
Oh Jester, really?!?!? I would stall without feeding him, and test again in 30 minutes. Hopefully he'll show he's rising and we can gauge the dose from there.
 
On 1/10 you shot the full dose on a lower than normal PS and he rose. On 1/11 same thing, but he went down, but only slightly.

Are you home today? Can you get an extra test or two if needed? If so, I would wait a little bit after he's eaten to give him time to rise, and then do the shot at the regular dose. There is a slight risk in that so you'll need to keep an eye on him. Odds are he'll be fine, but since it's lower than normal we can't really know until you try it.

If that feels too stressful, then lower back down to 0.75 or 1u. Again, since this is new, it's a guess for any of us, so go with whatever seems best to you.
 
Djamila said:
On 1/10 you shot the full dose on a lower than normal PS and he rose. On 1/11 same thing, but he went down, but only slightly.

Are you home today? Can you get an extra test or two if needed? If so, I would wait a little bit after he's eaten to give him time to rise, and then do the shot at the regular dose. There is a slight risk in that so you'll need to keep an eye on him. Odds are he'll be fine, but since it's lower than normal we can't really know until you try it.

If that feels too stressful, then lower back down to 0.75 or 1u. Again, since this is new, it's a guess for any of us, so go with whatever seems best to you.
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The kids kept me up on and off until 4:00AM.
I was supposed to go to a doctor's appointment, but I feel like an elephant stepped on me.
But I'm also waiting for a phone interview either before or after the appointment.
Plus, I *was* planning to shift Jester's shot time earlier starting today.
Obviously not happening.
 
Btw, he ate pretty well this morning. I think the Pepcid helped.
Usually I have to really push him for an hour to get as much into his stomach as he ate in just about forty minutes or less.
 
I might aim for +2.5 or +3 just so you're into onset. Although it sounds like you have a busy day, so go with whatever works best for you. Doctors and interviews are both pretty important!
 
Ca
Djamila said:
I might aim for +2.5 or +3 just so you're into onset. Although it sounds like you have a busy day, so go with whatever works best for you. Doctors and interviews are both pretty important!
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Cancelled doctor's appointment.
I'm exhausted.
Taking a nap after Jester's done eating.

He's up to about half a can and still nibbling.
 
Djamila said:
Doctors and interviews are both pretty important!
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Like as not, doctor appointments are more likely to get shunted in my life than anything else.

I wanted to get to bed earlier last night but needed to give Jester that pre-bed test and couldn't do it before 1:15AM (+4). Then he wanted to eat a little more.
Then the kids all wanted to climb on me to sleep while I wasn't asleep yet which makes it harder to get to sleep.
Then Bastian started fighting with Sage because she decided to settle in right next to him on my legs and I had to intervene.
Then I had to reassure Bastian that I still love him and there was room for him too away from Sage. But Bastian insists on kneading whatever he's going to sleep on for at least fifteen minutes and right before he settled down he decided something was incredibly important to check out on the floor. And when he jumped back on the bed, he had to start all over again preparing the area he was going to sleep on.

I started nodding off, but something they did woke me back up around 4:00AM.

My plan was to get up before 8:30, but that went into the crapper. I barely managed to get up by 8:45 so I could test Jester before 9:00AM - not much different than yesterday.

I love my babies, but damn I could use a decent night's sleep......
 
Djamila said:
On 1/10 you shot the full dose on a lower than normal PS and he rose. On 1/11 same thing, but he went down, but only slightly.
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Are you looking at my SS?
From his PM shot on 1/4/18 through PM 1/13/18 I was giving Jester 1U religiously. I didn't change anything until 1/14/18.

On 12/31/17 I was trying .75 to see if it would make a difference overall. After his numbers went up steadily after 4 cycles, I gave it up, not realizing I should give it a little longer.
Went back to 1U on 1/3/18; skipped AM shot on 1/4 because his BG was under 100, and back to 1U for the PM shot.
@Djamila
 
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Yes, it means the 1.25 would have most likely been fine. That’s how this works though - we don’t know until hindsight which decision was right. But next time we’ll be better able to take the risk.
 
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