Evie's numbers

AliceL

AliceL

Active Member
New thread because the previous one filled up too fast! Here it is for reference: https://www.felinediabetes.com/FDMB/threads/dosing-question.278585/#post-3081444

Tagging @Shelley & Jess / @Suzanne & Darcy who thankfully have been holding my hand while we navigate these uncharted waters of new low numbers for Evie.

Suzanne & Darcy said:
Good morning. I see she had a similar AMPS too yesterday and you shot the straight 1 unit. She’s relatively flat so far. I hope she will have a nice cycle and that you all can have a peaceful day.
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@Charlie (Evie's Dad) and I overslept this morning after that late night. We were an hour late with insulin so it was really surprising to see her hold a similar AMPS to yesterday.

Today she is 64 @ +5, I just fed her some LC food so I'll check her in another 30 mins to see if it is dropping too fast.

She has also earned another reduction this evening according to SGLS.
So 0.8U tonight?

Is it ok to be reducing dose this fast, I am worried she will come back full force in the 200s once her body catches up...
 
AliceL said:
Is it ok to be reducing dose this fast,
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Yes, sometimes, something just clicks and they start earning reduction after reduction and can scoot down the dosing scale - she'll let us know, and you'll know by testing.
AliceL said:
Today she is 64 @ +5, I just fed her some LC food so I'll check her in another 30 mins to see if it is dropping too fast.
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Is this really +5 after insulin or +4 because of the late shot? Asking because seen other members get timing mixed up because of late shots and I want to make sure she's safe and not really earlier in the cycle than appears. If really +5, another lovely cycle! :)
 
Shelley & Jess said:
Is this really +5 after insulin or +4 because of the late shot?
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It's really +5. I always note my shot & test times in the comment section of Evie's schedule just to double check myself if I make a mistake.
Insulin today at 6:53am and +5 test at 11:43am.

Shelley & Jess said:
I'll be waiting for the next test.
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She is up to 81 @ +5.5 now after some LC food @ +5, I'll check again in about an hour once food spike has passed. We are watching her closely.
 
AliceL said:
It's really +5. I always note my shot & test times in the comment section of Evie's schedule just to double check myself if I make a mistake.
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Perfect! I should've looked closer and done the math, your spreadsheet keeping is excellent! Was concerned of the possibility of it being earlier, I've seen it happen too many times - it's very important to know where you are in a cycle when you get a fast drop especially since she hasn't really had any yet for us to compare to.
 
AliceL said:
It's really +5. I always note my shot & test times in the comment section of Evie's schedule just to double check myself if I make a mistake.
Insulin today at 6:53am and +5 test at 11:43am.


She is up to 81 @ +5.5 now after some LC food @ +5, I'll check again in about an hour once food spike has passed. We are watching her closely.
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That’s great. This is a very good cycle. It’s good that you have only given LC.

It’s actually good that she’s earning reductions. If her body needs less insulin then that’s a good sign. If the dose needs tweaking and she needs a little more, we can always go back up. But who knows… maybe she will be earning even more reductions?:cat::cat:
 
98 @ +6.5
So I think we are on the other side of the dip now.
We have to go out to buy more strips now, should be ok to leave her for two hours right? I also just gave her a little more LC food because she was asking for it.
 
AliceL said:
98 @ +6.5
So I think we are on the other side of the dip now.
We have to go out to buy more strips now, should be ok to leave her for two hours right? I also just gave her a little more LC food because she was asking for it.
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Yes, you should be fine, looks like definitely on her way back up, I'd be comfortable leaving & good that you gave a smidge more food.

Alice & Charlie & Evie, you truly are doing great!
 
Okay guys, back to the no shoot number discussion:
Suzanne & Darcy said:
I would hesitate to shoot the full dose below 150. We don’t have data to support this.
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I agree, we don't have any data below the 179 shot from today, and things have been changing so fast for Evie over the last few cycles too.

If 150 at PS, we need to test the waters, I'd try no more than a 50% dose to start to see how she handles it - and would only do this this first couple times if you stalled without feeding and make sure she's flat or on the rise. Below that, down to 120 or so, either skip if you're not comfortable shooting that low yet or give a token dose of 10-25% for the first few times, again making sure to stall to see that she's rising. It's always tough to determine how much of a token dose to give. It's best to start with no shots/token doses/lower doses and work your way up with doses and down with PS numbers as you collect the data and learn how she does. Even a no shot gives us important data.
 
Ah rats, need to mention too, would only shoot a lower PS than you're used to if you're prepared - around & available to monitor, have lots of test strips and have appropriate foods on hand (LC/MC/HC) to steer the cycle as needed, if needed.
 
I will read your last few messages in a moment.
Just came to quickly ask - she is 286 at PMPS (+11.5), she has had no food since +6.5.
Must I still reduce her dose to 0.8U? She is eating right now, but I need to shoot soon.
If no answer I will follow protocol to reduce, just thought it was worth a question because she is so high again.
 
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AliceL said:
Must I still reduce her dose to 0.8U?
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No, it's up to you and the protocol you've decided to follow, your comfort level and your reduction point.

You've gotten a taste of what it's like to get lower greens the last few cycles - can you keep up that kind of testing and feeding, cycle after cycle, or would a bit of wiggle room work better for you?
 
Shelley & Jess said:
You've gotten a taste of what it's like to get lower greens the last few cycles - can you keep up that kind of testing and feeding, cycle after cycle, or would a bit of wiggle room work better for you?
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I'm not sure. Those greens are very addicting.
And I can give Evie all the time she needs for testing & feeding but I am just worried that I don't understand the tighter protocols very well just yet.

I just gave her 0.8U, on the fat side, should we just see what happens with that dose and then make a decision tomorrow on how to proceed going forward.
If nadir is not under 150 this cycle I would be keen to increase back to 1U tomorrow morning if that's ok.
 
AliceL said:
am just worried that I don't understand the tighter protocols very well just yet.
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Give yourself a break, you're doing great, it takes time to figure it all out. It's about what's best for YOU and Evie at this point in your journey.

AliceL said:
.... because she is so high again.
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I know how tempting it is to want to give more insulin because she's high at PS. It's hard, goes against what seems logical - she's high, she needs more insulin, but, nope - she can still go green from yellow :)

Dose changes are based on nadir - unless, of course, Evie is too low to shoot at PS and to keep her safe you need to skip or do a token dose for that cycle.
 
AliceL said:
Those greens are very addicting.
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They are! :D

AliceL said:
If nadir is not under 150 this cycle I would be keen to increase back to 1U tomorrow morning if that's ok.
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I wouldn't do that. The dose has been a little choppy the last few cycles - give her time to settle in and settle down and show us what 0.8u can really do, you never know, she might surprise us!
 
I would hold the dose for a bit (the .8) because it sometimes takes a few days for some cats to settle into a dose. I think some stability would be good for her for now — as long as she doesn’t earn another reduction (we can always hope.) And yes, greens are very addicting!
 
Shelley & Jess said:
Dose changes are based on nadir
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Of course, you are right...and I actually did know this but it is hard to keep emotions out of decision making, I'm so grateful that you and Suzanne are here to keep me in check :smuggrin:

Suzanne & Darcy said:
I would hold the dose for a bit (the .8) because it sometimes takes a few days for some cats to settle into a dose.
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100% agree. I've seen how Evie's reaction to a dose changes after a few cycles.

So I will hold 0.8U unless she earns a reduction.
It will be interesting to see how she reacts to 0.8U now.
 
Oh my gosh. That was so unexpected.
I didn't think that dip was possible on this reduced dose.
I can never relax ever again o_O

Reduction this evening to 0.6?
 
:)You should probably color code that cell with the 48 in it lime green. If you had tested her a little earlier - at +4 or +5, you probably would have seen the rate of drop was too fast and could have intervened with MC at that point and prevented a lime. But I understand. I looked at her spreadsheet earlier this morning and saw the 146 and thought…. Looks okay so far, I wonder if she will drop into maybe some higher greens today? I didn’t expect a lime. You did a great job handling it, by the way.

So since she’s being very tricky with us lately, we can’t trust her :) I would test quite a bit in the earlier portion of the cycle, even tonight on the +6 dose.
 
Suzanne & Darcy said:
By the way, how is Evie doing? How does she feel? How is her activity level? Appetite? Overall does she seem to feel better? How is her mouth doing?
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Seems so much better overall. The mouth looks very good, the redness along the gumline has almost disappeared.
Still loves her food. She has been chasing balls we throw for her, climbing our orange tree, stalking lizards & crickets in the garden.
She still likes to stay close to me so she was actually just sleeping peacefully next to me while I work when I remembered she was due for a test and caught that low number.

I really hope I haven't skyrocketed her BG now with that HC liquid snack mix.
I just stress ate a whole tube of Pringles myself so I can't blame her :D
 
I bet the more controlled blood glucose has really helped reduce inflammation overall for Evie and has helped the stomatitis as a result. This makes me really happy— I mean the fact that she must just be a lot happier now and feeling better overall. This is what it’s all about!
 
Suzanne & Darcy said:
When you moved to Portugal, did your cats have to go into quarantine?
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No, I think the only countries that require quarantine nowadays are islands such as Australia and Mauritius.
Pets emigrating to other places in Europe, UK, US, Africa etc have to have proper vaccine protocols and updated rabies titre tests.
The EU also requires a state vet check before entry.

My cats flew the day before us and had an overnight stay in Amsterdam at the famous pet hotel before being delivered to us in Portugal the next day.
 
AliceL said:
No, I think the only countries that require quarantine nowadays are islands such as Australia and Mauritius.
Pets emigrating to other places in Europe, UK, US, Africa etc have to have proper vaccine protocols and updated rabies titre tests.
The EU also requires a state vet check before entry.

My cats flew the day before us and had an overnight stay in Amsterdam at the famous pet hotel before being delivered to us in Portugal the next day.
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Wow. I think I would have been really stressed out about my cats being separated from me for that time — in the hands of other people and me nowhere near them to protect them. I haven’t heard of the Amsterdam pet hotel. And they brought your cats to you!

We had a member who moved to Ireland last year from the United States and she said it was a really big deal to get her cats into Ireland.
 
Suzanne & Darcy said:
I think I would have been really stressed out about my cats being separated from me for that time
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Oh trust me, I was a wreck for the whole 24hrs.
The flight from South Africa to Portugal doesn't allow pets in cabin so they had to be checked as live cargo in the hold... ie no one to check on them during the actual flight.
If that isn't bad enough, Evie was terrified and just voided her bowels everywhere; she had to go to the pet parlour for a good scrub when she arrived. Poor thing.
I felt even more sorry for my other cat Zara who had a shared crate with Evie and her bowels.
I'll never put my babies through that again so I guess we are staying in Europe for now.
 
Shelley & Jess said:
Below that, down to 120 or so, either skip if you're not comfortable shooting that low yet or give a token dose of 10-25% for the first few times, again making sure to stall to see that she's rising. It's always tough to determine how much of a token dose to give. It's best to start with no shots/token doses/lower doses and work your way up with doses and down with PS numbers as you collect the data and learn how she does. Even a no shot gives us important data.
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Based on this I'm thinking no shots and let's see how the BG behaves.
 
Ok. So what data from the no shot do I need to get? Would +2/+4/+6 be ok?
And feed as per usual? That's normally dinner and then a smaller portion later before bed.
 
AliceL said:
Ok. So what data from the no shot do I need to get? Would +2/+4/+6 be ok?
And feed as per usual? That's normally dinner and then a smaller portion later before bed.
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Go about your regular feeding routine and get whatever tests you're up for - +1 or +2 & +3 or +4 would be good and anything after that is a bonus! (Especially if you want to catch up on sleep)

+1 or +2 should show us a food bump and/or if she's gonna bounce and/or the duration of the last shot.

+3 or +4 might tell us if/how much her pancreas is working if the number is lower than PS and then get some sleep. :)

Tomorrow morning AMPS will tell us how well she did.

Prozinc is an in 'n out insulin - she can't hypo with no insulin.

(Sorry to keep disappearing today - I'm sneaking you in ;))
 
Shelley & Jess said:
(Sorry to keep disappearing today - I'm sneaking you in ;))
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Please don't apologise, I know people have their own lives. I'm just so grateful for your help at all.

So, she ate 3/4 of her usual portion at dinner time.
I managed to get a test in 2hrs after dinner - 166 BG
I held off feeding her anything else before I could get another test, only made it 3h45m after dinner before she started yelling at me - 161 BG
I might give her one more small snack this evening and let's see what the AMPS is like tomorrow.

As my morning is probably your late night/early morning, can I double check with you now what I should do with her shot at AMPS?

Would it still be right to follow your previous advice:
*Above 150, half dose - 0.4U (1 in my syringe)
*Between 120 and 150, token dose - The smallest reliable dose I could do is 0.2U (0.5 in my syringe). But I guess I could try halve that by eyeballing 0.1U if I need to.

Both options stall without feeding and double check she is flat or on the rise.
 
I would say if she is between 150 and her previous low preshot of 175 on June 17, that it’s your call whether you want to proceed with the reduced .6 dose - and as long as you are home to monitor. We have some data to indicate that this should be okay with a reduced dose - although Evie has been surprising us lately— so you monitor and intervene as needed. Between 120 and 150 proceed as you have outlined above. How does this seem?
 
Well, don't know if I should say it....but, looking good (so far) this morning!

Even though Prozinc is an in-and-out insulin one cycle can and does affect the next - it might take a cycle or 2 for her to get back on track after the NS (but we never know with Evie!)

Behave yourself for Mom today Evie - I'll be peeking in when I can!
 
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