Dosing advice

Hi,

In the last two days, the vet and I agreed (upon my recommendation, prior to us blaming the vet) to increase Douglas' dose to 2.75IU twice daily, however from speaking to a couple of you on here and also from his results in these days, can I have some advice if this was a good idea?

I have been unable to administer insulin the last two evenings as his PMPS reading has been under 10. I haven't been able to stall due to time restrictions, however would not be comfortable administering the insulin even if the next reading (20 mins later) was up by a couple of points.

I am conscious that the consistency of the insulin has been all over the place with only 3 days in the last week when I gave insulin twice. Any thoughts or ideas?

 

Hi Anna,

Sometimes when you get 'lopsided' preshot BGs it can help if you drop the dose down to a level that allows you to give insulin on both cycles. I'd suggest discussing with your vet whether dropping down to 2.25IU Caninsulin BID might help things (and maybe help a bit with the bouncing??), or switching to a gentler, longer-acting insulin. With current UK veterinary drug regulations I guess that would have to be Prozinc first.

I'm tagging @Panic to ask her to look at Douglas' spreadsheet and perhaps give you an idea of whether a switch to Prozinc might help improve his regulation. (I've not used Prozinc so can't help on that side of things.)


Mogs
.

 

Hi Anna, you already know my thoughts, I think. ...My feeling is that lowering the dose might enable you to shoot twice a day, have insulin in the system for more of the time, and help even out the numbers somewhat...
I also think Douglas is producing more insulin of his own and has become able to extend the insulin cycle at times. But the body may find it hard to deal with the skipped shots while the pancreas is still just healing....

 

Yes, ditto to what Elizabeth says - lowering the dose makes more sense at this point. Even if you still get higher than ideal PS numbers, the longer Douglas has insulin in him the better - skipping isn’t doing him any favours. If you can start to dose twice a day, you may find that pre shot numbers start to come down and then you look at the data mid cycle and consider the dose again then.

I don’t know how you tell your vet that you’re going to reduce (if you do) but you seem to have a good relationship so if you explain the logic from what you've learnt, you may be ok!

 

Absolutely makes sense to decrease, the skipping of shots is making me nervous just as his numbers are jumping up and down a lot and I don't know what damage this could do in the long term.

I am definitely hoping that Douglas is starting to produce his own insulin too and getting that one step closer to being regulated. Although I NEVER thought I would get yellow, let alone blue numbers so early on. I am going to drop to 2.25 from tomorrow and let my vet know - always better to ask for forgiveness then permission...right?

 

Good decision!
BTW have you tested again since the 8.8 at +12? Just to be absolutely sure he’s not still dropping?

 

Oh no, I didn't think to test him at that time! I just tested +13 and its at 11.1 (this is food influenced)

 

Ok that sounds safe. If it was me I’d probably test again before bedtime just for reassurance. A highish dose this morning coupled with his longer than usual duration (poss because his pancreas is coming out to play) means nothing is certain. And it’s always useful to have the data.

 

My GOLDEN rule

 

Hi @Diana&Tom , @Elizabeth and Bertie , @Critter Mom , @jt and trouble (GA) , @Panic

Douglas' PMPS is low again today at 8. I am going to stall for 20 mins and try again but I don't think I will administer insulin regardless of result. He did get a lower dose today of 2.25IU this morning, am I expecting changes (ie higher numbers PMPS) to quickly?

Any advice would be greatly appreciated

 

Hope this isnt your last nerve hes working on.

I'm sorry I cant give dosing advice. If I'm seeing what I think I'm seeing, looks like he's "toying" with the "idea" of OTJ
That or hes just teasing you. CATS!

 

I hope not either.

Don't you be toying with me bringing in 'OTJ'!!

 

Hmm it does look as if he’s producing some insulin of his own. It’s unusual for Caninsulin to have such long duration otherwise. It may not be ideal that you can’t shoot again tonight but look at the bigger picture of him being in much nicer numbers than when you started out... this is real progress! I’d get another test in this evening to see what direction he’s going in, and then you’ll just have to take the situation in the morning as it comes. I don’t feel qualified to give specific dosing advice but see what the others say about a dose in the morning perhaps. I’d expect him to be in the reds again but who knows!

 

Looks like its the same cycle and his number will be red again in the morning.

Do I almost need to decrease the dosage again by a larger amount (@Diana&Tom I know you don't feel qualified to give out dosing advice, this is more me talking out loud)

 

He’s only going up slowly so far isn’t he, but he will most probably start rising mote steeply soon.
Strictly speaking we’d usually say don’t mess about with dose too much in a short time, to give any new dose a chance to settle and be reflected in bg numbers. But the aim is always to keep insulin in the system so you don’t want to keep skipping. This is where you need the peeps who have a lot of hands-on experience and knowledge. Mogs doesn’t seem to be around today but may be later, or one of the others you tagged in your earlier post may comment. I think though if you do decrease the dose, it should only be in small increments at a time. I must admit that my instinct would be to try 2u tomorrow and see what that does. We’re all only guessing really until we hit a dose that seems to do what we want it to at that point (it may well change again).

Sorry I can’t be more helpful but that’s me thinking out loud too!

 

This is my thinking too, its been 3 days now in a row that only a morning dose has been given. It makes sense to me to go back to a dose that allows me to shoot twice a day and work from there.

I will see if anyone else offers any other advice in the meantime

Thank you!!

 

That gets my vote!

 

Hi Anna,

Only just seen this (got a lot of stuff to sort out for my civvie, Lúnasa, at the moment).

With the blues you're getting, I think you need to find out what's happening mid-cycle during the day. Those low PMPS values concern me because it's possible Douglas might be going even lower when the dose is at peak effect. Speculating here but I do wonder whether the rise you see in the PM mid-cycles and then the high AMPS the following day could potentially be a bounce, either from the low PMPS value or, potentially, from an even lower AM cycle nadir. Also, Douglas is going through some really big drops on the AM cycles of late (speed and magnitude not known without the mid-cycle readings). Big drops can also trigger big bounces.

As a precaution, it might be a good idea to drop the dose down again and see how that goes. Also if you could get some AM mid-cycle tests tomorrow that might help you get a better picture of what's going on.

Note: Particularly when a cat starts seeing lower numbers on Caninsulin then by and large you may need to ignore high PS values when determining the safety of a dose because a dose that can drop a cat from, say, high yellows down to mid-low blues can also be capable of yanking down reds to mid-low blues.

Caution needed.


Mogs
.

 

Hi Mogs, thank you for replying

You are absolutely right about needing to test throughout the day. I will be home at the weekend so can get this data together.

I gave Douglas 2IU this morning, just in case. It didn't occur to me that his numbers may go even lower throughout the day, but that makes perfect sense. doh!

 

Yes without other readings in context of whether it’s higher or lower than the last one, you can’t see what a single reading means. That’s why I’ve been saying test again in the evening after your +12 no-shoot readings... Douglas may have been still dropping. Can’t take anything for granted!

A curve at the weekend on a lower dose will be very interesting.

 

Nice curve today Anna and interestingly, almost identical to the one on 13/9 on a slightly higher dose.
Are you going to dose tonight?
Are you planning a curve on another dose tomorrow?
I wonder what others think...

 

Hi Diana,

I am planning on dosing tonight, todays curve was very good but that was on a 2.25IU dose. Should I increase the dose tomorrow already? With the last few days, I'm a little confused with dosing now.

Tomorroe is a curve day too

 

I wish I had an answer for you Anna. Personally I’d reduce to 2u just to see if it evens out numbers during the day - but as you know I’d rather not give definite advice. I wonder if Mogs is around @Critter Mom

 

Agree.

Douglas seems to run lower at night in general. The higher AMPS values may possibly be influenced by a bit of bouncing off lower numbers in the PM cycles. AM BG levels can also sometimes be influenced by dawn phenomenon. Not being able to give any insulin safely on some PM cycles doesn't help things either.

You got a PMPS value that was closer to being safe to dose on the 2.0IU dose yesterday evening. The 2.25IU dose on the AM cycle of the previous day gave you a PMPS that was too low to dose safely with Caninsulin.

My two penn'orth.


Mogs
.

 

Argggh, his AMPS reading this morning is 8.6? What should I do?

 

Hi Anna, that 8.6 is a 'no shot' number. ....If you've not yet fed Douglas you could 'stall' - wait without feeding for 20 - 30 minutes and then retest to see if the number comes up to a shootable level on its own.

 

I know it's frustrating, but the fact that he is needing less insulin is a good thing... Honestly...

 

Morning Eliz, I know

I have stalled this morning, due to retest in about 5 mins

 

Yes it is!
Just a thought, Eliz... if Douglas goes up at next shot, above 11 but not much higher, what do you think about a token dose??

 

+12.20 test is sitting at 9.3 so it is going up. Shall I stall and retest in another 20 mins?

I ideally would like to administer insulin, I am home all day so can monitor (just dont want to go back to high red numbers again and feel like starting from scratch (I know this is no my choice but Douglas and his insulin)

 

Yes, for sure you can do this!
Is Douglas OK with that...?

 

Yes, that could be a good option. Just a very small dose so that he has 'something' in his system.

 

I mean, the look he is giving right now suggests he isnt but I will give some extra lovin'. Only another 12 mins.....

 

He’ll probably go up a smidge and stay around that number for a little while then rising faster (guessing) so I’d suggest not to under dose too much.

A token dose is a small dose. A skinny or fat dose is a tiny bit under or above the usual dose. So for example 0.5u or 1u could be a token dose. A skinny 1.5u would be just under that.

Try to look at the trend of numbers in the last few days and try to forget the instinct to increase the dose - if anything, err on a slightly low side so you can see what that does and make it more likely he will be shootable for the next cycle.

 

Aw, bless him...

Another option - if it's still not shootable - is to feed Douglas and then retest in a good couple of hours. If the numbers are really scooting up at that point you could give some insulin, although still probably a reduced dose. And it may affect the timing of your PM shot... However, this is something that can be done with Caninsulin, unlike some other insulins....

 

+12.40 sits at 9.7, what do you think I should do? Is the token dose only for over 11 readings?

 

Looks like this is your best option, Anna. If you shoot something at say 10am, monitor all day and see where you are at shot time this evening.

 

Unless you have loads of data and experience, I’d say yes.

 

Thank you both! I will feed him as I think I am 10 seconds away from him clawing at me

I will test again at 9am and see (is 9 too early, I know you suggesting 10am but I don't want to be too out of whack with his shot timings).

 

See what Eliz says.
Remember that there is a bit of wiggle room with Caninsulin so if you shoot a lower than usual dose this morning and data shows he is definitely rising by pmps, you can shoot then.

 

The food will most likely elevate the blood glucose. ...The reason for waiting at least a couple of hours to do a preshot test is so that the preshot number isn't food-influenced.

So...you could indeed test at 9am, but that number may not be sufficiently 'true' to use as a reliable preshot number... It could however still be useful data.... And, thinking about it, if the number is rocketing up at that point (more than would be expected just from eating low carb food) that could indeed indicate that it may be OK to give 'some' insulin, albeit maybe a reduced dose.

I do totally hear you on wanting to give some insulin so that the blood glucose doesn't just skyrocket. And since you are home and can test, then you do have a bit more freedom to experiment a bit...

 

That makes sense. I have just tested him again, he's 12.6. He would usually have a little snack around now so gonna feed him and give him some insulin in about 20 mins. I think I will give 1.25IU.

 

Okey dokey, Anna. Since you can test today it could be an interesting thing to try.

 

Yes that’s a fair thing to try, I’d say. It really is trial and error and that dose could go either way - let’s see!

 

Well I'm ready for it!

Thanks again for all your advice and support

 

It's looking like a pretty nice cycle so far, Anna! ...And hopefully the PMPS won't jump up too high... Fingers crossed...

 

Looking really good! The dose might start petering out soon but you did shoot on a lowish bg so it may just last until amps... exciting!

 

Luckily it didn't go too low!

If numbers are back to 'usual' for PMPS, should I shoot the 2.25?

 

It looks to me as if the 2.25 is too high. In the last few days a shot of 2.25 has twice been followed by subsequent preshots that were too low to shoot...
I'm inclined to agree with Diana and Mogs about trying 2 units...
But this is just my 'two cents'....

 

I think wait and see what bg is when you get to ps time. If he’s having a nice little surf, he may not be in a hurry to go up too high. But then on this morning’s dose he may be well up again this evening.
I do have a bit of a fixation with a dose of 2u and would have liked to see yesterday’s curve on that number... but even 2u might be too high if he does really well today.
It’s really hard to say - not only do you need a degree in some kind of statistics to work this out, but you also don’t know if he’s producing insulin of his own, how much, and when.
Just take it one dose at a time for now.

 

Ok, thanks (just trying to make sense of all this. I think you are right, a degree in statistics would be extremely helpful)

I suppose my main question now is, can I change doses day to day? At the moment, is my goal trying to find the dose that I can administer safely twice a day?

 

very good question and just what I was wondering...Eliz will answer I think!

 

Yes, I'd say that this would be a good thing to aim for at this point; to find a dose that you can give twice a day so that Douglas can have insulin in his system for more of the time.
However...he may have other ideas!

I think what today has shown is that there is certainly some benefit in giving a reduced dose on occasion rather than skipping completely. And being able to do this may mean that you can give insulin twice a day sometimes even if one of those shots is a reduced dose...

 

Thank you both (again, again)

 

You’re very welcome, Anna, it’s what we do. We understand the struggles and believe me, if we had a magic wand to cure FD, we would! Remember, you can only do your best in the situation and you really are doing well.

 

Thank you Diana, the support on here is amazing

 

Douglas just tested a 21.7?! Blimey thats a big leap

 

You could say that! Insulin totally out of his system. You could re test though just to be sure.

 

You read my mind, just retested - 20.5

 

So the same. Ok so we know this morning’s dose was a tad low... that’s ok, the only way to figure this out is by getting whatever data you can for the different doses you try.

 

Absolutely! I will give him 2 tonight and see how we go with that.

 

It is a big leap, but it may have gone high much sooner if you hadn't given that 1.25 this morning...

It looks as though the insulin dose may really affect the insulin's duration with Douglas. So, that may well be why there was a short duration today. ...But this is all very useful data. And I think you've done a really brilliant job today!

 

Worth it for the cats in hats!!!

 

Just following this thread is amazing. Douglass you dont know it but you are ONE LUCKY KITTY CAT!

 

It's nice to see some sunny yellow pre-shots, Anna.

 

Thanks Eliz, surprisingly I am trying 1.5IU at the moment to see if that allows for twice daily shots so fingers crossed for the consistency of 2 shots a day. Also hoping to do some mid day testing tomorrow to get a better idea of how low he is dropping.

 

Wow, just seen today’s numbers! This is going really well I think you’ll have to take extra care with dosing now as even a tiny amount could make a significant difference one way or the other. Getting some mid-cycle tests tomorrow will be very interesting indeed.

 

Hi Anna,

Glad to see that reducing the dose is improving things.

Have you noticed any differences in Douglas?


Mogs
.

 

I know, I really want to be able to shoot twice a day so his numbers stay as consistent as they can.

Douglas is definitely changing. His coat is softer and has less dandruff. He is also more vocal (not fun at 4am right in my face, but will take that over high BG numbers any day) and jumps up on my lap now. My favourite thing was that he is now coming to sleep next to me which he did from the first day I picked him up

I hope todays testing day will help paint the picture of hows he doing and how low his numbers go. Will probably come back here for advice once the day is over.

 

Anna, you’re doing amazingly well! That was a brave move shooting 1u last night but it worked and you got your first green! Ok so he’s back in the yellows this morning but in a way that’s good as you can experiment with dose and monitor today - all part of the route to seeing the results you want.

So nice to hear that Douglas is happier - just shows how how sensible treatment can give such an improved quality of life (for you as well as him!)

 

Yay!!!

 

Beautiful curve so far today, Anna - get the insulin ready to catch that rise before it goes too high!

 

Oh I'm not sure what you mean? Does that mean I can shoot before the twelve hour? And do I not want the number to go higher than 15 (number from AMPS)

 

Sorry Anna, I only meant make sure you test and shoot on time... sorry if I confused you. You could though test and shoot a bit earlier if you think he’s rocketing up...

 

Fair enough. I think I took your message too literal

With regards to next steps, what would they be? Do I continue for another 5-7 days at 1.5, keep an eye on numbers and if not decrease, imcrease dose by 0.25IU?

 

Well, you would usually stick to a dose for four cycles (I think) to get a clear picture of how that dose is working - that’s the case if you’re increasing the dose to get bg down, but right now you’re experimenting with lower doses, which do seem to be effective. See what @Elizabeth and Bertie and @Critter Mom say about dose. It does seem though that Douglas may be producing some insulin of his own and as his pancreas heals he will need less exogenous insulin, so you will have to continue to be vigilant as you get into lower numbers.

 

Seconding everything Diana says above.

Anna, I think you're developing a really good understanding of how Douglas responds to insulin. And your experimenting with lower doses has produced really positive results. (This is so different to what you were seeing even a week ago... Things have moved on a lot since then...)
I think you're on the right track with what you're doing - in fact I think you're doing a brilliant job. ...I would just reiterate what Diana has said above about Douglas possibly now producing more insulin of his own. And therefore it will be important to be vigilant, and to be responsive to any further reduction in his need for injected insulin...

 

I do feel much more confident with how his insulin is working and glad I have been able to find a safe dose so far. Hopefully with this consistency for a few more days we can see the numbers change a bit so I know the next plan of attack.

I am glad I dosed the 1 unit the previous day. I was so determined no to skip another dose, and it seemed to have paid off.

As they say, one step closer.

Douglas and I thank you all for your help and support!

 

It's looking good, Anna.

...Any chance you can get a test this evening? ...Am wondering if Douglas's insulin needs are still decreasing...

 

Yes do check if you can, Anna, best to be safe...

 

Will try

I was surprised to see such a low reading on PMPS following the lower dose this morning.

 

yes... this possibility of Douglas producing his own insulin is something to be very aware of. You’ve done so well to dose on lowish preshots, effectively slowing a rise, but on lower numbers like you’ve been getting you do have to be extra cautious. His need for insulin is clearly lessening and a dose that was ok one day could be too much another day... not saying that that’s definitely the case but be aware that giving any dose on a ps of 10 does need careful monitoring.

 

Noted. I suppose I didnt expect things to change so quickly. He's already on 9.2 so will monitor closely

 

You’re both doing brilliantly! And again, not saying that there’s anything wrong with your dosing, just that you need to be fully on board with the possibilities. It’s a whole new ballgame now compared with not long ago when you were getting reds!

 

Eeek 3.8 at +4.5. Currently eating some high carb food and testing in 30 mins.

 

Did you want help with this? I can tag someone for ya

 

I think you know the drill Have honey or karo ready...already eating HC

 

Thanks @jt and trouble (GA)
Gonna test again in about 5 mins, see if the HC food is ok. I 'think' I got this, thank you for keeping an eye on me though

 

AHHHH you know the tag good for you!

 

Up to 5.9 after a teeny bit of maple syrup and some more HC food. Hypo averted.

Although, the glucose meter SCREAMS at you when it has such a low reading... And at 1am in the morning, its pretty loud

 

I dont think hes out of the woods are you going to wait 30 and test again?
Please tag who you want to guide you.

 

I can do, I'm up anyway

 

Not that you dont know what you are doing just as a precaution

 

I was going to sign out for the evening but will stay and keep you company

 

7.6 at +6, roughly same numbers as my last curve (slightly higher) so happy its going up. Hopefully numbers wont be too high at AMPS.

@jt and trouble (GA), thanks for the company and support!

 

Do you feel this is safe territory?

 

He seems to respond to HC food well.

 

I need to start dinner but will keep checking until you say you got this.

 

I do feel it is

Responding to food is what Douglas does best, I seriously believe he could constantly eat if I kept his bowl full all the time but that makes it easier when low numbers appear, happy to munch on some gravy covered richness