? Dosing Help with history of DKA, vet wants to go from 2iu to 3iu

Spreadsheet now updated. Looks like Toby is going to put me through a low cycle and thus uneasy night. It's great to see some lovely low numbers though, we just need to both learn it's ok and not a scary place!
 
Kate, Toby is looking great! I love that blue and it's very safe and you're already at the point where the insulin is reaching peak action. Feed him a little snack of LC food to keep him surfing around the same range and test again in a half hour after he eats.
 
Well that was an interesting night me and Tobes had burning the midnight oil together. It was all going smoothly and then at +7 he tested at 1.9... I gave him some food and also 5 high sugar treats, I sat with the glucose syrup at the ready and left it a very very long 15 mins and tested again...he was 4.1... when he was tested at 1.9 he was his usual chirpy self and displayed no signs of being low whatsoever.

My questions are:
Would the sugary treats bring him back up from 1.9 to 4.1 that quickly?
Was the 1.9 a rogue reading?
Where does this leave me with dose?

Thank you all in advance x
 
Hi Kate, well done for staying calm and in control... it must have been rather scary to see that 1.9 (btw I don't see this on your ss so would be good to add it when you get a sec).

Ok so yes - a few sugary treats could well make bg rise in a few minutes and if you look at the two numbers - 1.9 and 4.1 - they're actually only two points apart and just what you wanted to see. It's possible that the 1.9 was a rogue reading, yes, but in a situation like that you can always re-test to be sure.

As to where that leaves you with dose, it's a question of looking at the data and trying to work out a best guess at any given point - there are rarely any "right" answers, it's trial and error! I'm not one to give dosing advice but I expect Linda will be along soon and comment.

Hope today goes well!
 
Good catch Kate! My Toby and you had quite the night.

Any time you get a reading that low or strange, retest with another strip just to be sure that it isn't a wonky strip. I take it Toby had no symptoms of that low BG? Head wavering, stumbling or wobbly on his feet, food searching etc.

I would also put that 1.9 reading on the SS so anyone helping knows you got that low reading for future. You can stack the readings like this in the +7 cell. Just use the space bar to separate the 1.9 and 4.1 readings.

Wally.PNG

The sugary treats will raise BG fast but can take a few minutes to work. Honey or corn syrup work almost instantly. The important thing is you did what you needed to do and Toby is safe.

As for dose going forward, Toby earned another reduction and dose should now be 1.75u. I see you gave him 2u again this morning so be sure to watch him closely. He was high this morning due to a bounce from the low BG last night however he's dropped back down considerably (almost 50%) by +3 today so you may be in for another active cycle. Lows like last night can make kitty a bit more sensitive to insulin.

For future reference, any drops to 5 mmol or less earn an immediate dose reduction of 0.25u.
 
It's going to be interesting to see where Toby is by PMPS. He bounced but it looks like he's clearing it pretty quickly. :) Bounces can last up to 6 cycles for some kitties.
 
He's full of surprises, after so many blacks to see the lovely low numbers is brilliant!

Its strange, the 2iu seems like the right dose for daytime cycles but too much at night, I've read night is often when they dip lower, is it out of the question to have a different am and PM dose?
 
There are kitties who do well with different doses day/night but it's more common to dose consistently for both cycles. I wouldn't consider the different dosing on a regular basis until you get Toby a little more regulated. His numbers are improving and he's been getting some lower readings during the day too. You may not however be seeing all of them because of limited daytime testing compared to night time. And of course there is the bouncing which generally calms down as kitty gets more used to those lower readings.

To keep Toby safe, you could give a reduced dose at night when PMPS is lower such as it was last night but right now his insulin needs seem to be changing a bit so I think I'd try to keep dosing consistent so as not to muddy the picture with different dosing day and night. My suggestion would be that if Toby's PMPS is below 250, reduce dose by 0.25u for that night and monitor early so you can steer him if he is dropping fast.

That 1.9 last night was seriously low and you don't want him doing that. It looks like he started dropping a fair bit around +4 last night. When you see a drop of 50% over a 2 hour period, you need to try to slow the drop down with some food and on a night cycle, a bit higher carb food can be given to keep him surfing at a nice safe level.
 
MrWorfMen's Mom said:
There are kitties who do well with different doses day/night but it's more common to dose consistently for both cycles. I wouldn't consider the different dosing on a regular basis until you get Toby a little more regulated. His numbers are improving and he's been getting some lower readings during the day too. You may not however be seeing all of them because of limited daytime testing compared to night time. And of course there is the bouncing which generally calms down as kitty gets more used to those lower readings.

To keep Toby safe, you could give a reduced dose at night when PMPS is lower such as it was last night but right now his insulin needs seem to be changing a bit so I think I'd try to keep dosing consistent so as not to muddy the picture with different dosing day and night. My suggestion would be that if Toby's PMPS is below 250, reduce dose by 0.25u for that night and monitor early so you can steer him if he is dropping fast.

That 1.9 last night was seriously low and you don't want him doing that. It looks like he started dropping a fair bit around +4 last night. When you see a drop of 50% over a 2 hour period, you need to try to slow the drop down with some food and on a night cycle, a bit higher carb food can be given to keep him surfing at a nice safe level.
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Thank you Linda for your detailed reply. I hear what you're saying and will keep things consistent. I went with 1.75iu. It's a real rollercoaster hey! Yes I agree, he seems to drop quickly.

His appetite and thirst has definitely decreased over the last 24 hours, I was having to refill his water glasses around the house an awful lot, and that has significantly reduced.
 
The major drop from 28 down to 11 in 4 hours last night seems to have set off a bounce. Swift drops as well as lower numbers will set off bounces. He'll come back down.
 
MrWorfMen's Mom said:
The major drop from 28 down to 11 in 4 hours last night seems to have set off a bounce. Swift drops as well as lower numbers will set off bounces. He'll come back down.
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Thanks Linda, appreciate the reply. Do you agree to hold steady at 1.75iu?

He is super happy in himself, the best I have seen him in many months, which gives me no end of joy and hope. x
 
Yes I'd hold the dose for the time being. If Toby drops below 90 again, you'd reduce by 0.25u again. I'd suggest re-evaluating the dose in 3 or 4 days as it can take that long for bounces to clear.
 
Amps 3.4 so it's no shoot for us this morning..... just when I think I'm getting it something strange happens...I leave for work in 40 mins so will retest.

Amps + 40 mins 3.8.

Food and sweets given and no shoot.
 
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I responded on the other thread. You handled Toby's BG great. Seems he is on a bit of a mission these days which is terrific even if a bit scary for you. Hopefully he won't bounce quite so high this time.
 
I can only assume I inadvertently did a fur shot last night based on the super high readings I consistently had all night.

He was a bit sleepy and drank a whole glass of water over night too, my poor babe.

Feeling very disheartened and cross with myself for messing up :-(
 
Stop kicking yourself Kate. That may just be an overly dramatic reaction to those lows. Some kitties bounce a little and some shoot to the moon and Toby had high numbers the last time he went to green too. Fur shots happen to all of us so just make a note in remarks that it was a possible furshot and carry on. Toby will get back to business soon enough.:)
 
MrWorfMen's Mom said:
Stop kicking yourself Kate. That may just be an overly dramatic reaction to those lows. Some kitties bounce a little and some shoot to the moon and Toby had high numbers the last time he went to green too. Fur shots happen to all of us so just make a note in remarks that it was a possible furshot and carry on. Toby will get back to business soon enough.:)
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Thanks Linda, we are back on the positive tonight and hes coming down nicely. The spoilt boy has had, sheba, sea bass and organic chicken breast tonight and is laid flat out stuffed!
 
Morning All,
@MrWorfMen's Mom I was wondering if you would be so kind as to take a look at Tobys SS please, I have been trying to test him less as per the advice of the vet however I have noticed that his nadir has become much earlier in the cycle, at +4-+5 and then he shoots up again at +6-+7 and remains high until the next pre shot. When before his nadir was +7 ish and he was nice and steady (albeit too high).
I have increased his dose to 1.75iu after a good number of days of being too high.

I appreciate all thoughts and musings on this as I am lost, just when I thought I was beginning to understand!!

Thank you all in advance.
 
Still really high again tonight, and drinking lots and lots. 1.75iu given and I'm watching him closely. Waiting patiently for a wee to test ketones.
 
@MrWorfMen's Mom

Hi Linda, just tested for ketones and we have 1 grade higher than a trace. I'm devastated. Its quarter to 10 at night here in the UK, I will of course take him to vet in the morning. But what should I do now? Hes eating and drinking well still.
 
Are you sure you read the strip in good light and exactly at the 15 seconds or what ever time frame yours require. The strips tend to darken with time so if you are late reading them, you get a false higher reading.

If you're sure, I'd push fluids even if you need to syringe some water into Toby, make sure he gets all the food he wants (adding water to his wet food helps too) and I'd up his insulin to 2u tomorrow AM if his pre-shots are still in the black. His BG doesn't seem to be moving much.

What about his teeth? I'd have the vet check if that's not been done lately as they can often be the source of high BG. Keep us posted.
 
Yep, I followed the instructions exactly, and it was a mid flow test

His teeth were checked 3 weeks ago and I was told they were ok.

His BG has been high for days and days now, it must be that.

I'll keep fluids up and keep feeding, looks like a vet visit in the morning.
 
MrWorfMen's Mom said:
:( I was so hoping you got distracted or were looking for better light. Keep us posted and give Toby some scritches for me.
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Thanks Linda. I'm beyond gutted. I've just managed to syringe 15ml of water in him. And hes in the garden in the dark drinking a puddle (heavy rain here roday), thankfully also chasing moths so hes feeling ok.

I will test throughout the night, give 2iu in the morning and then get him to the DRs.

Poor babe, hes been so chipper of late, very upsetting.
 
What a handsome little fella! The fact that he is feeling well enough to enjoy the garden is good to hear. Hopefully this is just a blip quickly overcome with a little more fluids and insulin.

Come on Toby......get rid of those ketones!
 
Nice work looking after Toby, Kate. So happy to hear ketones are negative this AM. Keep an eye on them as you work to get Toby's BG down more.
 
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