Hello, Positive note-Squeaks' numbers are definitely looking better! Does the current dosing look good right now? I was a little hesitant to give him 1.25 U when he tested in the 130's at PMPS then the next AMPS so I was giving him 1. However, at his +7, he was back in the 200's! Just looking for advice on how to handle these situations.
Squeaks may be bouncing a bit. The 1.5U dose looks like it's a bit too much for him. So you reduced to 1.25U. Then you got a lower than expected pre-shot so gave him a reduced dose. So hold the 1U dose for another few cycles, to see where this amount takes him. See if he clears the bounce. Hold the dose for several more cycle, 2 maybe 3. Then let's reevaluate. Remember, you're not dosing based solely on the pre-shot test, but how low the nadir is for him. You want to be able to give the same dose, both AM and PM cycles (unless he drops below 90 mg/dL). How about next time Squeaks is lower than expected at pre-shot, but >170 you give him his full dose. Think you would be ok doing that? Over time, you should be able to gradually lower that pre-shot threshold where you decide to give the full dose of insulin or a reduced dose. Let's help you get there, ok?
Hi Deb, I can definitely do that. I started the 1U this morning. If he's below 170 at pre-shot, should I adjust at all or still give the 1U? Just to confirm, is a cycle a "day" (24 hours)?
According to your SS, you started the 1U on 5/5/20 PM cycle. So Squeaks has been at this 1U dose for 4 cycles now. If Squeaks is < 170, your new shoot/no shoot threshold number, you stall. And post for help, preferably in the Feline Health forum where there are more "eyes" to help you make a decision. (Because Deb can't be on 24 hours a day ) Stalling is not feeding and testing again in 20 minutes, to see if the BG's are rising. You can stall for up to a total of 1 hour with Prozinc, and keep to your usual shot schedule. I wouldn't recommend stalling more than that 1 hour. If the BG's are rising, and getting close to or above your threshold number to give insulin, then give the full dose. If the BG's are fairly steady or falling only slightly (within 20% meter variance), but still below your shoot/no shoot threshold, you make a choice to give Squeaks a reduced dose of some amount. That reduced dose can be anywhere between 10% to 25% of his usual dose. Some people that have enough test data, even do a reduced dose that is 50% of the standard dose. But to do that, you need to do a bit more monitoring, absolutely getting a +2 and maybe some other tests later through nadir. Doesn't matter if it's the AM cycle or the PM cycle. You'd need to keep a closer eye on your cat if you're being that aggressive with the reduced dose. If the BG's are falling a lot, you skip the dose and pick things up with the next dosing cycle. There are exceptions to skipping. For instance, a cat that has had or has ketones should never have a skipped shot. A high dose cat should never need a skipped shot, but a reduced dose and closer monitoring. (Squeaks, at 1U is NOT a high dose cat.) A cycle is 12 hours. Based on the time between insulin shots, which is 12 hours. So there are 2 cycles in a 24 hour period. We say cycle instead of day, because sometimes the dose changes in the PM shot time, so the time overlaps into the next day. So Squeaks is due for a curve this weekend, where you test every 2 hours from pre-shot to the next pre-shot. I'd like to have you stay on the 1U dose until you do the curve. Of course, the exception to staying on that dose would be if Squeaks gave you a BG number below 90 mg/dL before that. Then you would reduce. Just like the SLGS protocol says.
Oh yes, that's right! I didn't realize that it had been a few days of reduced amount already. Thank goodness for that spreadsheet! Thank you for the info on stalling and how to adjust based on what I'm seeing. I will definitely do a curve on Saturday and check back in next week. Thank you so much for your help! I'm learning so much and Squeaks is doing so much better!
