? Dosing Advice Requested

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Bruce Wayne

Bruce Wayne

Member Since 2021
PMPS @243 , +5 @66

This is his second hypo (that I’ve caught) in the last few days. I bumped him down .25 after his last hypo episode, but this is a cat that usually pre-tests in between 300-400. Should I bump down another .5 tomorrow you think?

I will of course get a amps and I’ve got my hypo kit out and gave him some honey, kibble and 2oz wet food and water. I will take his blood again once it’s been 2 hours since he ate.

I don’t want him to keep having hypo episodes bc they can go south so quick. Does reducing a 3.2 to a 2.5 seem reasonable ? Or should I reduce to 2.75 ?

(I know I need more bg tests. I am definitely working on that and we are doing much better with that. I owe so much thanks to JanetNJ)
 
I hadn't heard back, so I just gave him 3units this morning, since he was over 400 for AMPS. I will probably give him 2.5 units tonight. Let me know if anyone thinks that is a bad idea.
 
Why aren't you testing before shots?
When you test more you'll avoid the hypos.
26 of March he was probably too low to shoot at PMPS, but with no test and insulin anyway he got a severe hypo.

Do you know the protocol about hypos? I'm not seeing more tests when you get a neon green, and I'm worried you might not continue testing afterwards
 
we just started home testing less than a month ago, and it took us a while to get accustomed to it. So this week has been the first consistent week. But I keep the same dose for 3 -6 cycles unless he has a hypo incident. I try not to change his dose regularly, as we do the SLGS method.
 
Bruce Wayne said:
I am testing before. I also am following the hypo protocol. Is my chart not updating for you?
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When having a low, we test every 15 minutes, or at least every 30 minutes until they're high enough not too, and keeping themselves up without food for 2 hours
On the 26 you got a 60, and three hours later a 20. No tests in between?
 
okay. this is the first time I am reading this. I understood the hypo protocol to include feeding them. I did see the testing every 30 minutes, but then I also read that the number will be misleading bc the food will curve the numbers. To get a true read without influence of food, to wait 2 hours. Is that not correct?
 
Bruce Wayne said:
okay. this is the first time I am reading this. I understood the hypo protocol to include feeding them. I did see the testing every 30 minutes, but then I also read that the number will be misleading bc the food will curve the numbers. To get a true read without influence of food, to wait 2 hours. Is that not correct?
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Only on preshots.
And the point is to get the numbers back up with food, the alternative is a dead cat :eek::nailbiting:

We ONLY withhold food two hours prior to the pre-shot, of course NOT when the cat is having a hypo. Anywhere in between we feed small meals throughout the cycle to steer the curve. When having a hypo, we definitely feed, as high carb as possible, adding honey if needed.

You're darn lucky he made the 20's on a pet meter. That's not just low, that's like really low :nailbiting:
 
Tagging @JanetNJ and @Deb & Wink and possibly @Critter Mom in case any of them are online before I am later, I have to leave for the day. Sasha is right, 20 is extremely dangerous in general, much less an Alphatrak.

Never base a dose on pre-shot, never give more insulin just because it's high.

I might drop down to 2u from quick glance but see what the others suggest.
 
And you can test whenever you want too, regardless of food.
Getting a +11 might tell you, that you'll need help do figure out next dose, and then you got an hour to get help.
+1 might tell you if the blue pre-shot is on it's way back up, or if you get a good food bump, or heading down.
Right now, I'm testing an feeding every hour. Not because I need to, but out of curiosity really.

When we base dosing on nadir, the lowest point of the curve...we kinda need the testing around nadir. Before that, testing to find where it is. And it is very possible it moves from day to day, like their BG in itself. That's why we test.

We test do determine dosage, to prevent a hypo, to keep them safe. Testing is the only way to keep them safe. So even though we sound like a broken record, I really hope you'll test more. Before every single shot, and at least one in each cycle unless a hypo is on it's way, then way more.

I'll hope you'll test more, read some sticky's around here and learn some more :bighug:
And I'm sorry if I seem hard, it's not my intention. My intention is to keep Bruce safe :bighug:

And I freaking love his name!!! :smuggrin:
 
Okay! Yeah- I know you are trying to help. And I do appreciate all of the help I can get.

It is just hard bc it's just me. I don't have a spouse or family here. I am not going to be working from home anymore starting next week, so it is going to be impossible for me to check during the day and to help the curve with food. Like right now, I am giving him lunches and I am worried that it will backfire when I can't give him lunch anymore. The automatic/timed feeders favor dry food and I don't want him back on that. All I can really do is commit to every 12 hour shots. 630 and 630 is the goal for me, but even that can vary slightly depending on work.

I can commit to the pre shots, and I can get some + # when I am home from work, but I fall asleep around +6 so ..:banghead:. This is just a lot of information, and not all of it clicks with me, but I am trying to absorb all of it.

He has had a trend of going lower at night, even when he was on Vetsulin. So- I may just need to do 3u in AM and 2u in PM until I can do a whole curve on the weekend. :blackeye::blackeye::blackeye::bookworm:
 
SashaV said:
And you can test whenever you want too, regardless of food.
Getting a +11 might tell you, that you'll need help do figure out next dose, and then you got an hour to get help.
+1 might tell you if the blue pre-shot is on it's way back up, or if you get a good food bump, or heading down.
Right now, I'm testing an feeding every hour. Not because I need to, but out of curiosity really.

When we base dosing on nadir, the lowest point of the curve...we kinda need the testing around nadir. Before that, testing to find where it is. And it is very possible it moves from day to day, like their BG in itself. That's why we test.

We test do determine dosage, to prevent a hypo, to keep them safe. Testing is the only way to keep them safe. So even though we sound like a broken record, I really hope you'll test more. Before every single shot, and at least one in each cycle unless a hypo is on it's way, then way more.

I'll hope you'll test more, read some sticky's around here and learn some more :bighug:
And I'm sorry if I seem hard, it's not my intention. My intention is to keep Bruce safe :bighug:

And I freaking love his name!!! :smuggrin:
Click to expand...

<3 Thank you for caring about him and giving me the tough love. I am trying.
 
Bruce Wayne said:
Okay! Yeah- I know you are trying to help. And I do appreciate all of the help I can get.

It is just hard bc it's just me. I don't have a spouse or family here. I am not going to be working from home anymore starting next week, so it is going to be impossible for me to check during the day and to help the curve with food. Like right now, I am giving him lunches and I am worried that it will backfire when I can't give him lunch anymore. The automatic/timed feeders favor dry food and I don't want him back on that. All I can really do is commit to every 12 hour shots. 630 and 630 is the goal for me, but even that can vary slightly depending on work.

I can commit to the pre shots, and I can get some + # when I am home from work, but I fall asleep around +6 so ..:banghead:. This is just a lot of information, and not all of it clicks with me, but I am trying to absorb all of it.

He has had a trend of going lower at night, even when he was on Vetsulin. So- I may just need to do 3u in AM and 2u in PM until I can do a whole curve on the weekend. :blackeye::blackeye::blackeye::bookworm:
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Keep the dose the same, possibly 2.5 in each? @Panic will adress that later.
I'm alone in this too.. I set an alarm for my PM tests. I go to bed right after her PMPS I can't do on only 6 hours of sleep. Leave him food if you need to leave the house.
 
Okay.
When you leave, do you leave dry food? Or do you have a way to leave healthier options without them eating it right then and there ?
 
Bruce Wayne said:
<3 Thank you for caring about him and giving me the tough love. I am trying.
Click to expand...
I know you're trying! :bighug::bighug:
And I know it sucks, and it's hard being alone in this! Gosh I know all about it :eek:
More testing now when you're home, so you can somewhat predict cycles to when you go back to work. I'd still leave food out, though.

Dryfood is baaaaad. It kicks in later and last looooong. In my cat it almost took a week before she was back to normal after dryfood. I leave canned food out.
 
So I just took his +11 and he is at 99. He is scheduled to eat soon and get his shot. Should I skip tonight and try to reset him tomorrow maybe just only at 2u AM and PM? It almost seems like maybe he only needs one shot in the morning and not at night? I am sure I will need more data before we could assume something else though.

@JanetNJ and @SashaV and @Panic
 
Bruce Wayne said:
So I just took his +11 and he is at 99. He is scheduled to eat soon and get his shot. Should I skip tonight and try to reset him tomorrow maybe just only at 2u AM and PM? It almost seems like maybe he only needs one shot in the morning and not at night? I am sure I will need more data before we could assume something else though.

@JanetNJ and @SashaV and @Panic
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don't give one shot a day because it won't last. Sometimes prozinc gives you 12-14 hours of duration. . If at shot time it's still under 200 stall without feeding for an extra hour and we will see what it is. I wouldn't skip tonight, but we may need to reduce. I love that his insulin needs are coming down but it does make it tricky to know what to do.
 
Okay. I will wait another hour without feeding. He is gonna go crazy about not eating, but it's for his benefit.

I will post back in an hour to tell you what his new number is. You're probably right. 2.5 is what I will try tomorrow AM and PM (assuming he keeps his bg high enough for me to shoot).
 
Bruce Wayne said:
@JanetNJ at +12 he’s @125. Maybe I should just do a 25% shot ?
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Please make sure you test tonight. I would have told you to wait an hour past shot time and stall to see if it's going up. 125 is pretty low. I would do the first test two hours after the shot. If it's about the same or gone down you are going to have a long night of testing.
 
Bruce Wayne said:
Okay! Yeah- I know you are trying to help. And I do appreciate all of the help I can get.

It is just hard bc it's just me. I don't have a spouse or family here. I am not going to be working from home anymore starting next week, so it is going to beAQNY433XJ8EYNZ1RBTQo check during the day and to help the curve with food. Like right now, I am giving him lunches and I am worried that it will backfire when I can't give him lunch anymore. The automatic/timed feeders favor dry food and I don't want him back on that. All I can really do is commit to every 12 hour shots. 630 and 630 is the goal for me, but even that can vary slightly depending on work.

I can commit to the pre shots, and I can get some + # when I am home from work, but I fall asleep around +6 so ..:banghead:. This is just a lot of information, and not all of it clicks with me, but I am trying to absorb all of it.

He has had a trend of going lower at night, even when he was on Vetsulin. So- I may just need to do 3u in AM and 2u in PM until I can do a whole curve on the weekend. :blackeye::blackeye::blackeye::bookworm:
Click to expand...

I see a lot of members use this auto feeder comes with 2 ice packs for wet food

https://www.chewy.com/cat-mate-c500-digital-5-meal/dp/154556?utm_source=google-product&utm_medium=cpc&utm_campaign=hg&utm_content=Cat Mate&utm_term=&gclid=Cj0KCQjwmIuDBhDXARIsAFITC_63x-luggpCkFZRkS8gkKWhzRbyN2QiluSdQbUAVg-nyE2iitAjCY4aAjTmEALw_wcB


Extra ice packs
https://www.amazon.com/Mate-Replacement-Pack-C500-Feeder/dp/B07M6MVMGM/?tag=felinediabetesfdmb-20
of 5 stars Identical to original ice packs that came with my Cat Mate C500
Reviewed in the United States on September 21, 2019
Verified Purchase
So glad could I was able to find these! A great price and identical to the set that came with my Cat Mate C500 automatic pet feeder. Very useful if I’m going to be away all day and need ice packs 2 days in a row.

I doubt I’ll *need* to get another set, but if I do, these are certainly worth it.
 
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Also you need med and high carb food on hand in case he drops too low and you need to bring his BG up to safe numbers
You can add these wet foods either HC or MC or LC depending on what is BG since you said next week you will no longer be working at home.

Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs



Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy. 15% Med Carbs




Fancy Feast Gravy Lovers Turkey Feast in Gravy. 15% Med Carbs


Fancy Feast Gravy Lovers Chicken and Beef Feast in Gravy 15% Med Carbs

Or any other ones listed in this food chart

https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/
 
Bruce Wayne said:
Thanks Diane and Janet! I updated his spreadsheet and am hoping we dodged a bullet tonight. I will try to make some of these purchases in the morning.
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Ah yes I see it went up. Looks like he was just getting longer duration last night. Let's see how he does now on 2.5
 
Glad to see Janet was able to help you yesterday!

A few things. Get an auto feeder (Petsafe 5 is a popular choice) so Bruce will have food during the day AND night. We typically recommend food at onset (for Prozinc this is often at +2), and a couple more times before nadir. For example, my girl would onset at +2 and nadir around +6, so she would get snacks at +2, +4, and +5.

Try to get tests in at +2 every cycle, this will be a good indication for how the cycle is going to go. Noticeable drop? Keep your eyes out, test more often. The same or higher than pre-shot? Probably a quiet cycle (but never assume, get a before bed test in if night time, get another mid-cycle during the day). Do what your schedule allows, not everyone is retired and home all day to test, but there are people here who work 12 hr shifts and keep their kitties safe as well.

I would alternate your testing times for a few days to figure out Bruce's nadir. Say one day test at +1, +3, and +5, and another day at +2, +4, +6. Rough guidelines, it's just meant to fill in the gaps in your spreadsheet so you understand what Bruce does and can plan accordingly. You may find that Bruce naturally has a long duration, or an early nadir, etc etc.

Another thing is although Bruce has had some VERY low numbers, as long as he hasn't shown any sort of hypo symptoms, it's not considered a hypo event.

Always drop the dose by 0.25 units (more if experienced board members suggest it) if Bruce's BG drops below 90 at ANY time.

Understand what bouncing is. Bouncing is a phenomenon that occurs when the body experiences (or at least thinks it does) hypoglycemia. Luckily the body uses bouncing as a defense mechanism against this where it attempts to compensate the low blood sugar by dumping excess glucose in an attempt to raise blood sugar back to “normal” numbers. Unfortunately, “normal” is a relative term according to the body. For a diabetic whose body has been untreated for so long that it considered very high numbers to be the new normal, lower numbers can often make the body overreact in attempt to save itself, even if it’s not in danger.

A cat who has been suffering from diabetes for some time may at the point of diagnosis have a new “normal” of 400. When insulin is introduced and brings it down, even to 200 (still diabetic levels), the body thinks it is in danger, dumps excess glucose, and thus the blood sugar skyrockets up to the 400-600s. After enough time has passed, the body will eventually realize that 200 isn’t such a bad number, and bouncing will happen less often. Note some cats are extremely bounce-prone and a switch to Lantus/Levemir is needed.

There are three main causes of bouncing: when blood sugar drops too low (hypoglycemia), drops lower than the body is used too, or by dropping too much too quickly. Typically if a cat drops more than 50% of their blood sugar a bounce is likely to happen, or if they drop 100 points within an hour.

While bouncing can be considered as a safety net in the instances of hypoglycemia, it can look very confusing on paper.

Often times pre-shots are going to be the highest numbers you see. This can be due to a bounce (kitty dropped lower at night and came up in the morning for example) or even if kitty got into some high-carb food, or was stressed out over something. Point is, never give more insulin just because the BG is high - you base dosage on how low a dose takes a cat, not how high they currently are. They don't need more insulin if the BG is high, that's not how insulin works. Increase slowly - you only want to give more insulin if after 3-7 days of numbers consistently staying over 150.
 
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