Dosing question: Should I be reducing or raising the shot?

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Hello,

I've never posted to the forum for a dosing question before, but my cat's latest string of numbers have me frustrated. A little background, Simba is 1.5 months from being 18. He was diagnosed in December 2011, and then spent a lovely year at the falls. He was rediagnosed in December 2012, and we are back on the juice. His condition includes inflamed liver and constipation.

Once he started getting Miralax his numbers came down into a workable range. Then all of a sudden his regular shot started to carryover into the following day, giving AMPS in the low 100's, so either I am getting really skilled at the fat layer shot or the shot is too much now. So the vet had me try to adjust at will to his test numbers, and that worked a little, but we just had a week of icky weather that seemed to aggravate his arthritis. A little buprenex assisted that, but his numbers were back up in the reds and pinks. (He had an all blue day today, first day out of the crappy weather.) His PM numbers were back in the high 300's (some of it food).

My question is, on a .4 -.6 shot his BG plummets and sometimes hits nadir around +3/ +4 instead of his usual +6 / +7, then the shot wears off early leaving him in the 300's by preshot. Is this common for a smaller shot? Or do I need to increase rather than decrease? Or is a further decrease needed to get him to a nice preshot number as well as a green nadir? In the past I would have shot a 1u or 1.10u on a 300-500 number and everything was great, but now even those preshot BG's tend to hit the 2 digits on .6 or lower. What am I missing??? confused_cat

Also important to note we are still using U-40 syringes, so all these smaller shots under 1.0u are eyeballed.
 
Re: Dosing question: Should I be reducing or raising the sho

Hi and Welcome!

I think several things could be going on. One, it looks like you are going to be shooting lower doses. If I were you, I'd invest in some U100 needles so you can shoot consistent lower doses. (at those small amounts, just a little more or a little less can mean the difference between a blue number and a green one.). There were some free needles in the supply closet or Rob said a bag of 10 was inexpensive at Walmart. The important thing is to get the ones with half unit markings. Sometimes the pharmacist has to scrounge around for them but they do carry them. But you have to use the conversion chart as you are using a U40 insulin with U100 needles:

http://www.felinediabetes.com/insulin-conversions-printer

Yesterday during the day, if you could have gotten a number around +10, and it was over 200, you could have shot less than the .6 (maybe a .2 or .4) and he might have kept himself low. You can "chase" the numbers and mini dose when they are headed for remission. So, when you have to skip, monitor until he reaches 200, and shoot a tiny bit. It throws your schedule off but it usually doesn't last very long.

One way to see if his pancreas is functioning, is to test before feeding and then test 30+ minutes after. If his numbers go down with the food but without a shot, his pancreas is starting to work. It can "wake up" in fits and starts so it makes this OTJ journey a little harder to predict.

Let's see what others think, but I think I would get the U100 needles and reduce the dose by a hair on the pinks. You're getting a +50% drop on the 300s or you are getting a long cycle with an unshootable amps. When you do get an unshootable amps, chase the numbers and shoot that tinydose when he reaches 200. (I have no idea whether this is possible with your life, but it would be wonderful if it is)

Does any of that make sense?
 
Re: Dosing question: Should I be reducing or raising the sho

Yes! That's makes perfect sense! I shot a .25ish on a 194 at +3 on 3/1 and it did exactly that, he went down to 78. This morning's AMPS is 245, so the goal would be to keep him in the blue/greens?
 
Re: Dosing question: Should I be reducing or raising the sho

Yes, that's the idea. Shooting mini doses when he goes over your target. But if you do that, you want to be able to monitor. Yesterday the PZI kitty, Floyd, got .25 on a 200 and crashed to 39. Mom was watching and was able to bring him steadily up and he was fine. His pancreas seems to be contributing and that complicates predictability.

The other thing that helps are small, frequent meals which will support the healing of the pancreas.
 
Re: Dosing question: Should I be reducing or raising the sho

Simba has always been a grazer, he eats a little here, a little there as the day goes. Lately, his body is finally talking to his brain and telling him when to eat on the low numbers. I am home today and able to monitor. On work days, I am mostly able to get a +3, and then come home for a +6. At night, I set the cat nap alarm, and I can test as frequently as needed.
 
Re: Dosing question: Should I be reducing or raising the sho

AMPS: 245 - .4u
+2 - 159

It appears we are in for an interesting day. @-)
 
Re: Dosing question: Should I be reducing or raising the sho

Mary,
That looks good to me, but I think I would opt for a +4 in case he decides to make it more interesting.

Carl
 
Re: Dosing question: Should I be reducing or raising the sho

AMPS: 245 - .4u
+2 - 159
+3 - 114

So far so good. He can feel the drop, he starts pacing the food dish to make sure the buffet is ready when he needs it.
 
Re: Dosing question: Should I be reducing or raising the sho

If he drops under 100 by the next test, go ahead and give him a spoon of low-carb and it'll slow things down some.

Carl
 
Re: Dosing question: Should I be reducing or raising the sho

AMPS: 245 - .4u
+2 - 159
+3 - 114
+4 - 122

Must have had a bite to eat around +2.5. He was sleeping in the window next to me for the tests at +3 & +4, so it had to be an earlier nibble kicking in.
 
Re: Dosing question: Should I be reducing or raising the sho

Btw, great picture. I love the expression on his face.

Looks like a nice gentle smile shaped curve, so far. :-D
 
Re: Dosing question: Should I be reducing or raising the sho

AMPS: 245 - .4u
+2 - 159
+3 - 114
+4 - 122
+5 - 139

Hmm... Not really sure. One of those days? He seems a little mopey...(dare I say it? BLUE! <--lack of sleep). Maybe his legs are acting up. :YMSIGH:
 
Re: Dosing question: Should I be reducing or raising the sho

AMPS: 245 - .4u
+2 - 159
+3 - 114
+4 - 122
+5 - 139
+6 - 126

His curve is like a wiggly smile.
 
Re: Dosing question: Should I be reducing or raising the sho

AMPS: 245 - .4u
+2 - 159
+3 - 114
+4 - 122
+5 - 139
+6 - 126
+6.5 - got up for lunch, sat out in the sun on the patio for a little bit with his FF Turkey.
+7 - 142
 
Re: Dosing question: Should I be reducing or raising the sho

AMPS: 245 - .4u
+2 - 159
+3 - 114
+4 - 122
+5 - 139
+6 - 126
+6.5 - got up for lunch, sat out in the sun on the patio for a little bit with his FF Turkey.
+7 - 142
+8 - 137

Simba is so cute. Now he's just messing with me. :-D
 
Re: Dosing question: Should I be reducing or raising the sho

What a nice long string of blues! When you factor in the 20% variance that meters have, they are basically the same number. It's encouraging that he is just surfing along in the blues.
 
Re: Dosing question: Should I be reducing or raising the sho

Sue and Oliver (GA) said:
What a nice long string of blues! When you factor in the 20% variance that meters have, they are basically the same number. It's encouraging that he is just surfing along in the blues.

This has been a nice change from the last week of 300's. He's been enjoying the spring today.
 
Re: Dosing question: Should I be reducing or raising the sho

AMPS: 245 - .4u
+2 - 159
+3 - 114
+4 - 122
+5 - 139
+6 - 126
+6.5 - got up for lunch, sat out in the sun on the patio for a little bit with his FF Turkey.
+7 - 142
+8 - 137
+8.5 - had a snack of FF Liver & Chicken
+9 - 138

He's sleeping upside down trying to hide his ears from his vampire mommy. :twisted:
 
Re: Dosing question: Should I be reducing or raising the sho

Very nice day!
Carl
 
Re: Dosing question: Should I be reducing or raising the sho

AMPS: 245 - .4u
+2 - 159
+3 - 114
+4 - 122
+5 - 139
+6 - 126
+6.5 - got up for lunch, sat out in the sun on the patio for a little bit with his FF Turkey.
+7 - 142
+8 - 137
+8.5 - had a snack of FF Liver & Chicken
+9 - 138
+10 - 163

Jump from his afternoon snack or sunshine overload?
 
Re: Dosing question: Should I be reducing or raising the sho

We want to see the smile, headed back up toward preshot. Wonder if he will be above 200 at preshot?
 
Re: Dosing question: Should I be reducing or raising the sho

AMPS: 245 - .4u
+2 - 159
+3 - 114
+4 - 122
+5 - 139
+6 - 126
+6.5 - got up for lunch, sat out in the sun on the patio for a little bit with his FF Turkey.
+7 - 142
+8 - 137
+8.5 - had a snack of FF Liver & Chicken
+9 - 138
+10 - 163
+11 - 193

Inching ever closer to the yellow....
 
Re: Dosing question: Should I be reducing or raising the sho

AMPS: 245 - .4u
+2 - 159
+3 - 114
+4 - 122
+5 - 139
+6 - 126
+6.5 - got up for lunch, sat out in the sun on the patio for a little bit with his FF Turkey.
+7 - 142
+8 - 137
+8.5 - had a snack of FF Liver & Chicken
+9 - 138
+10 - 163
+11 - 193
PMPS - 201!!!!

Okay so now we have a sticky situation. Try for a smaller shot? Or wait? Or hold the shot?
 
Re: Dosing question: Should I be reducing or raising the sho

Well, he is rising. He had a great cycle today, but you started with 245 at .4, not 201. I think, because it's night and you can't monitor as well, I'd go with a smidgen lower. Maybe .2? We can always go back to .4 tomorrow if it is not enough. What do you think?
 
Re: Dosing question: Should I be reducing or raising the sho

Sounds good. He seems to be wanting to surf tonight, maybe we'll get lucky. :mrgreen:
 
Re: Dosing question: Should I be reducing or raising the sho

Do you think he would be okay with a .4? I can monitor all night. Would it put him too low?
 
Re: Dosing question: Should I be reducing or raising the sho

I don't know, Mary. He would probably be fine. I am a cautious doser; Carl is the braver one. But you are the one holding the needle and if you can monitor and feel good about it, go for it. He didn't go in the greens today so he has room to drop.
 
Re: Dosing question: Should I be reducing or raising the sho

Okay, so I thought I'd go with the .4, but I think I may have done a furshot, but I tend to think every shot that small is a furshot. So it might end up being a .2 anyway. LOL. Or a really rough night. I need to shave a target on his back.

Thank you so much for your help today. Tomorrow I might be a little more cautious depending on how tonight goes. Tomorrow is work, so I won't be able to monitor as frequently as today, but I'm glad to feel somewhat back on track.
 
Re: Dosing question: Should I be reducing or raising the sho

Saw he dropped quite a bit for +2. I think you'll need to watch carefully. If he gets down to the 40-50 range, post on Health for help. Have you copied off the Hypo information?

(if I give you the hypo info, I figure you won't need it. :-D )
 
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