Dosing guidance - starting over

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Yvonne & Andy &BJ (GA)

Yvonne & Andy &BJ (GA)

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We are starting over - dropped from 6u to 2u. Values yesterday 8am -59 - no insulin - vet visit - 5pm - 412 - 2u.
At 8am this morning: 442 - gave 2u
Test @11am: 142
Do you agree 2u appears to be too much?
His breakfast was 95% DM wet 5% FF. Seems like a very quick drop..........
 
Yes, it is a fast drop. I'd plan on getting a test in an hour to see if he continues to drop. If he would get to 50, give him some regular food. Retest in 20 minutes. If he continues to drop, then give me a little gravy off higher carb food. Retest. If he drops below 40, rub some honey on his gums and consider a vet trip.

The high numbers this am and last night are likely a bounce mid cycle. If he was in low numbers at nadir, then his body releases extra glucose. That makes his next levels bounce up. That's why the nadir numbers are so important. If he bounces from highs to lows, you want to reduce the dose and get him off the roller coaster.
 
Sue and Oliver (GA) said:
Yes, it is a fast drop. I'd plan on getting a test in an hour to see if he continues to drop. If he would get to 50, give him some regular food. Retest in 20 minutes. If he continues to drop, then give me a little gravy off higher carb food. Retest. If he drops below 40, rub some honey on his gums and consider a vet trip.

The high numbers this am and last night are likely a bounce mid cycle. If he was in low numbers at nadir, then his body releases extra glucose. That makes his next levels bounce up. That's why the nadir numbers are so important. If he bounces from highs to lows, you want to reduce the dose and get him off the roller coaster.
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Sue - I just tested and he was 79 so gave some food. He acted starved! I am convinced that the reason they could not regulate him at the clinic for 4 wks was this bouncing. Didn't they used to call it somogi - probably dating myself! I had real problems with my first diabetic cat with this.
 
Sue and Oliver (GA) said:
Yes, it is a fast drop. I'd plan on getting a test in an hour to see if he continues to drop. If he would get to 50, give him some regular food. Retest in 20 minutes. If he continues to drop, then give me a little gravy off higher carb food. Retest. If he drops below 40, rub some honey on his gums and consider a vet trip.

The high numbers this am and last night are likely a bounce mid cycle. If he was in low numbers at nadir, then his body releases extra glucose. That makes his next levels bounce up. That's why the nadir numbers are so important. If he bounces from highs to lows, you want to reduce the dose and get him off the roller coaster.
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Sue - I reported below he was 79 - I fed abt 1/2 can of ProPlan Natural Chicken and Turkey in Gravy
I retested 1 1/2 hrs later and he is now at 51 - gave him a scoop of DM dry

Can you imagine what was happening when he was getting 6 units! He is lucky he's still alive. My poor baby.
 
I bet he was dropping very low and bouncing all over the place.

I'd rub some honey on his gums or add it to the gravy in the food. 51 is very low for AlphaTrak. You need to bring him up.
 
Sue and Oliver (GA) said:
I bet he was dropping very low and bouncing all over the place.

I'd rub some honey on his gums or add it to the gravy in the food. 51 is very low for AlphaTrak. You need to bring him up.
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Thank you. He came up after the dry DM. He is now at 128. It is 2 hrs before his next regular mealtime and testing. Since he's coming up now, I hate to stick him again. I think I need to lower his dose regardless. What would you do at this point?
 
I'd imagine he won't go down again, but I wonder if he will be high enough - above 200- to shoot. If he is not, you may have to skip.

If you do skip, he is likely to be high at the next pre shot because he will be have been 24 hours since the last shot. Regardless, I would reduce to one unit. (My thinking is that you don't want to shoot the dose that gave you a low number and an unshootable pre shot.)
 
Sue and Oliver (GA) said:
I'd imagine he won't go down again, but I wonder if he will be high enough - above 200- to shoot. If he is not, you may have to skip.

If you do skip, he is likely to be high at the next pre shot because he will be have been 24 hours since the last shot. Regardless, I would reduce to one unit. (My thinking is that you don't want to shoot the dose that gave you a low number and an unshootable pre shot.)
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OK - 1u is half his recommended restart dose - I'll go with that and will post his results. Thx.
 
Yvonne and Andy said:
Can you imagine what was happening when he was getting 6 units! He is lucky he's still alive. My poor baby.
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Well, you've got a LOT of company in this experience, Yvonne. Can't begin to count how many times we've seen this same scenario happen: Kitty is sent home on a high dose of insulin; then immediately needs a much lower dose. While it's important to get the numbers down - especially when DKA is happening - I think that sometimes vets forget to factor in "stress hyperglycemia" when determining a dosage ... and then when the kitty's no longer stressed out by being in the clinic or hospital, those BG#s go way down @ home ... & a hypo situation ensues. Which you handled beautifully, btw - great job!:)

I have little doubt that you're going to do just fine in getting Andy regulated!:bighug:
 
Hi Yvonne! Wow! Sounds like things are getting interesting for you. You've done great so far! I'm so glad that you are going with a lower dose now. :)

@Robin&BB HI!!! So glad you're back!!!!!!
 
Yvonne and Andy said:
OK - 1u is half his recommended restart dose - I'll go with that and will post his results. Thx.
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It may not be quite enough, but my idea is that it is always easy to raise the dose slowly and carefully based on your home testing numbers. It is hard and a guessing game to decide how much to reduce a dose that is too high, as you saw with the 6 units. I'd give it 3 cycles and if he is higher and flat, then raise by 0.25 units.

Are you getting ketone tests? We use ketone strips just like humans use. If he won't let you insert the strip in his urine stream, we have ways. (Oliver wouldn't let us be in the same room when he peed.). I'd get a test daily while we are fiddling around with the dose.

Welcome back, Robin. We missed you !
 
@Yvonne and Andy - Hi, Yvonne! Looks like (in your signature) that you have a spreadsheet started for Andy, but it can't be seen ... can you go into your Google sheets settings and set so that it's viewable? Will look forward to hearing about how it's going for you and Andy.:)
@Rachel , @Sue and Oliver (GA) - Howdy! Missed you, too!
 
Sue and Oliver (GA) said:
Yes. It just needed its own space. Looks like she is gradually coming down on 1.5 - nice and slow.
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Would you look at tonight's # - starting from 416 and 1 can ff down to 106 after only 5 hrs at 1.5 units - I think he is still bouncing at 1.5 - maybe I need to go to U100 syringes and tweak this more.

I can't believe he was originally on 6 units!
 
On my laptop, your spreadsheet didn't update. There is a place on the share tab for updating or on the publishing tab (Ican't access the spreadsheet link on the laptop.)

Anyway, yes, that is a huge drop. Not only will he feel lousy dropping that far, he will definitely bounce. Two choices: you could try to feed the drop, if you can be around. So test in the 2/3 hour window and if he starts down, give him a little snack of his regular food and see if he will flatten out. Or reduce the dose by a smidge.

If you are able to monitor, my first choice is the first one. The nadir number is good and not too low, so the dose is reasonable. It's just the bounce back up. If feeding doesn't flatten, then reduce by a little. Reducing by 0.25 would be ideal.

And yes, the U100 needles would make that easier.

SO glad you are testing!

Saw you gave one unit. That should be fine.
 
Sue and Oliver (GA) said:
On my laptop, your spreadsheet didn't update. There is a place on the share tab for updating or on the publishing tab (Ican't access the spreadsheet link on the laptop.)

Anyway, yes, that is a huge drop. Not only will he feel lousy dropping that far, he will definitely bounce. Two choices: you could try to feed the drop, if you can be around. So test in the 2/3 hour window and if he starts down, give him a little snack of his regular food and see if he will flatten out. Or reduce the dose by a smidge.

If you are able to monitor, my first choice is the first one. The nadir number is good and not too low, so the dose is reasonable. It's just the bounce back up. If feeding doesn't flatten, then reduce by a little. Reducing by 0.25 would be ideal.

And yes, the U100 needles would make that easier.

SO glad you are testing!

Saw you gave one unit. That should be fine.
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Sue - I did give him abt 1/4 can ff at the +5 106 reading. I will work on the spreadsheet.

The spreadsheet publish tab was set to update automatically every time????
 
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Yes the spreadsheet should update automatically every time you add data. You can see all your updates and the ones that it has saved if you click on the "All Changes Saved in Drive." You can find this link to the right of your tool tab i.e. File, View, Insert, etc. Sometimes you might see "Last edit was made xx minutes ago." Once you click on either one, it will give the saved changes on the right and your screen will turn black and white. To go back to your spreadsheet, just click on the "back" arrow which is found on the top left.
 
Merlin said:
Yes the spreadsheet should update automatically every time you add data. You can see all your updates and the ones that it has saved if you click on the "All Changes Saved in Drive." You can find this link to the right of your tool tab i.e. File, View, Insert, etc. Sometimes you might see "Last edit was made xx minutes ago." Once you click on either one, it will give the saved changes on the right and your screen will turn black and white. To go back to your spreadsheet, just click on the "back" arrow which is found on the top left.
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Cindi - Sue could not see my latest update - can you?
 
Sue and Oliver (GA) said:
I can't. Can everyone else?

My thinking is to feed him around +2/3 when he starts down. If the food flattens him out then, it might make the nadir less drastic.
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I asked Cindi above if she can view but no reply yet. How can we find out?
I am uncomfortable w the 1u results, especially for overnight. I think I may go to the U100 and drop down to .75 dose and see how that looks.
 
I can see it, Yvonne. Yep, that's still a deep drop. Can you test again @ +6 or +7 just to see where he's heading?
 
Just realized your +4 was nearly an hour ago ... and appears that the redux to 1 unit is making the drop a bit less than you saw in last night's cycle.
Will be interesting to see what kind of # you get at PMPS time tonight. (Boy, isn't it amazing how far Andy's come, just since the 17th?;))
 
Yes I can see the last update too. Agree with Robin that a test in about an hour or two would be good however he is still in a good range right now and he is probably close to nadir. When you give him some food, be sure to give him the low carb food. He doesn't need anything higher in carb yet. Usually, the regular, low carb food can slow them down enough. Also do not want to give him a whole lot because you do not want him to get full. For Merlin, typically a tablespoon is plenty to get him to slow down or flatten out. Andy is really reacting to insulin very well...just need to figure out what he needs still. Good job in testing.
 
And before I forget: I see that you're feeding him twice a day, which is fine ... but in the event that you ever elect to give him a little snack somewhere else in the cycle, avoid feeding him in the 2-hour window directly before his pre-shot test (as this will "artifically" raise his preshot BG# with food).

This would not apply, of course, if you happened to be dealing with a true hypoglycemic event within that time frame. (In that case, if you were dealing with a hypo that close to shot time, you'd most likely be skipping that shot anyway!;))
 
Robin&BB said:
Just realized your +4 was nearly an hour ago ... and appears that the redux to 1 unit is making the drop a bit less than you saw in last night's cycle.
Will be interesting to see what kind of # you get at PMPS time tonight. (Boy, isn't it amazing how far Andy's come, just since the 17th?;))
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Yvonne and Andy said:
I asked Cindi above if she can view but no reply yet. How can we find out?
I am uncomfortable w the 1u results, especially for overnight. I think I may go to the U100 and drop down to .75 dose and see how that looks.
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He was 343 and I gave him .8u and switched to U100 syringe (2u) - fingers crossed.
 
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