Eyes Please +5 53, +6 107, PMPS 225

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pixiegirls & Boy

pixiegirls & Boy

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I was able to get a middle of the night (4:45 am) nadir for Boy as was suggested....92 [1u ProZinc @ PMPS]. This morning, his AMPS was 248 and I continued the 1u ProZinc. Will be interesting to see his midday numbers. I did feel bad for his AMPS.....had to stick his poor little ear a few times, so he's not exactly a happy camper. Finally realized that when I bought more lancets yesterday, and needed to calibrate a OT Ultra2 , I must have used the new OT lancets the last two times. It figures the pharmacy also gave me only a 30 gauge box of lancets instead of the larger 27 I had asked for.....no wonder it was so difficult to get a sample.

After going over the low-carb treat list, I did find and purchase the Halo freeze dried chicken. I wanted something soft for Boy's teeth/tooth, but realized when I saw the freeze dried chicken, he had had them before without any problems and loved them.

At least I was somewhat productive after getting up at ~5:00 am to check Boy's BG in finishing a 12/24 auto-calc BG curve spreadsheet.....
couldn't get back to sleep for the life of me anyway and now my templates are working.

I hope to do more middle of the night BG checks to see the difference with the day/night levels. Thanks Sue for all of the help!
 
Re: Boy 5/1/2012 nadir & AMPS

Good data. Two ways this can go..he can get used to the greens midcycle and not bounce(assuming that's what he is doing) so your preshots gradually come down. Or he can get lower midcycle numbers. If you continue to get green nadirs - say in the 70 range, you might reduce the dose a little. more numbers will help us see what is happening. The good news is that at these numbers, he is already technically regulated!

Hope he likes the treats - they are vital to the process :-D
 
Re: Boy 5/1/2012 nadir & AMPS

Thanks. It's those low mid-cycle numbers he's had that I'm hoping don't occur. I'm hoping that he will get more consistent green numbers at mid-day. I will definitely keep trying to get more numbers for him though. It's been great not seeing any of the 300-500+ numbers any longer too. I like the sound of him being regulated!

My mom used to feed her cat the freeze dried treats and Boy would get some when visiting and loved them.
 
Re: Boy 5/1/2012 nadir & AMPS

Hi and Welcome to our group.

Beautiful numbers you are getting. Interesting about not giving insulin on 4/26 and his next PS was 100 points lower. What was the story with that?

I havn't been around much lately so sorry if it is alreay on here somewhere.

Robin
 
Re: Boy 5/1/2012 nadir & AMPS

Hi Robin,

Thanks for the welcome. I was a little surprised with that 100 pt. drop on 4/26 as well, then figured since he was going down in dose maybe that was why he didn't do too bad. He didn't get the insulin on the 26th, or have his BG checked until later because I seriously overslept. The two days before were exhausting with my mom one day and Boy the next.....guess I needed the rest. Now I make sure I have alarms set.

He's been on 1u after reducing from 1.5u....which seems to be working well.
 
Re: Boy 5/1/2012 nadir & AMPS

Thanks for the explination, maybe oversleeping was a blessing in disguise. Going 24 hours without insulin and then giving you a blue number is pretty impressive and makes me wonder if the 1 unit might be too high of a dose for him.

I think I would be tempted to lower the dose and see if you can't keep him out of the yellows completely.

Do you have a no shoot number? I personally wouldn't shoot him on anything under 160.
 
Re: Boy 5/1/2012 nadir & AMPS

I think like Robin, you probably can lower the dose and get some better numbers. Some cats really don't need much insulin, but you don't know until you try!
 
Re: Boy 5/1/2012 nadir & AMPS

Robin,

I am thinking along the same lines of reducing his dose and waiting for the vet to get back to me (sent her his numbers/curve, etc. and need to exchange the U40 needles for U100). He's been consistently on 1u since the 28th. He obviously reacts to the insulin very well now. My no-shoot number is a little iffy now, but 160 sounds reasonable. The last no-shoot instructions I got from one of he vets was under 100; 1u if 100-200, and 2u if over 200.....not so sure if that is what is primary vet would go for though. I definitely wouldn't shoot if under 100, and didn't want to go up to 2u even if he was over 200 to prevent the bouncing. I won't be too surprised if he is in the 160's-170's at his PMPS either. I'll be checking his BG shortly to see where he's at now.

You're right.....oversleeping did seem to be a blessing. I was so freaked out when I woke up so late and he hadn't had his insulin or BG checked, then surprised that it had gone down anyway from the night before. I didn't bother with the shot when I did get up after his vet said it's better to skip a dose and go up rather than try catching up.
 
Re: Boy 5/1/2012 nadir & AMPS

I'm okay reducing his dose. I'll see what his +6 reading and PMPS numbers are.....I can always make sure I get a +6 after tonights dose too. I can figure out a .5u and get as close to a .75u as I can with the U40 needles I have. The less insulin he's on, the better! He certainly hasn't had any major BG rises when he's skipped a dose, so it is worth a try.

Thanks!
 
Re: Boy 5/1/2012 nadir & AMPS

Since non diabetic cats have bg's anywhere from 40 to 120 I think that 1 unit between 100 & 200 is a little aggressive and possibly dangerous.

We usually tell new members not to shoot if bg is under 200 until they have enough data to know that its safe but since you have been shooting lower numbers we can see how he reacted to them. I think 160 is a nice safe no shoot number for Boy.

As long as you are on board with reducing I might try the .5u it should be easier to eyeball and will be enough of a reduction to have an impact right away.

Are you testing for ketone yet? If not you should get some Ketostix and start, as soon as we start lowering doses it becomes more important.
 
Re: Boy 5/1/2012 nadir & AMPS

Argh.....I must have jinxed myself and Boy. His midday (+5) is 53.

I wasn't too thrilled with the guidelines either, and then his primary vet said to just stick with 1u for a bit. It was another vet in the practice who gave me those guidelines and knew they didn't jive with a lot of Now that he's dropping into the 50's again at midday, going to a .5u dose is probably the best.....and definitely much better to gauge on the syringe.

I have not been testing for ketones yet at home (and I know I should). I do know his last ketone test was negative (he was running mid 400's). Ketostix are on my list of things to get today at the pharmacy when I grab the other lancets, etc. Testing for ketones will be a real trick with 2 other cats. Plus....it's hard to really ever catch him in the litter box (he's shy about that so goes when no one is around, lol). How often do most people check ketones?
 
Re: Boy 5/1/2012 nadir & AMPS

Get another number in 20 minutes or so to be sure he isn't going lower. We don't want to see him in the 40s.
 
Re: Boy 5/1/2012 nadir & AMPS

That 53 is about an 80% drop. Don't be surprised if you see a much higher number at PMPS from a panicky liver. Boy hasn't really bounced much before but he might on this.

Feed him some regular low carb food to slow the drop and I would test again in 30 minutes to make sure it doesn't drop much more. If it does then feed him some higher carb food to bring that number up some. If he drops below 40 rub some Karo on his gums.

Also change your subject line in your first post to something like "Eyes Please +5 53" to get more people here".

I'll stay with you untill others show up, then I need to go home from work.
 
Re: Boy 5/1/2012 nadir & AMPS

I will Sue, but doubt he will. He just had some high carb FF which will help......but I always check anyway. Looks like he wasn't all that thrilled with this morning's food.....ate less than half, but did eat out of the other two cat's bowls. Might not have eaten enough. He's killing me with this sudden pickiness. I'm pretty sure I can get him to eat more consistently with the Friskies pate (that I give the other 2 more often)....just need to recheck the list for the lowest carb ones. The vet will hate that, but if he eats it then it's better than nothing.
 
Eyes Please +5 53, +6 107

His BG is now 107. He only had about 1 oz of the high carb food (didn't finish it all, so the others will I'm sure). He usually does come up quickly. Since he's only had one 12° glucose curve done, but I have been charting his daily numbers the same way recently. His lowest numbers are somewhere from +4 to +6 after insulin.
 
Re: Boy 5/1/2012 nadir & AMPS

I just got home. Looks like you had an interesting afternoon! How many hours into the cycle is he?

Carl
 
Re: Boy 5/1/2012 nadir & AMPS

OK and that 107 was around +6? You might've seen some of the food hit already, but I'm guessing the next test will show more of it.

I'm going to take a look at the SS and see what I can figure out dose-wise...but I'm agreeing with "just stay at 1u" is probably not the way to go!

Carl
 
Eyes Please +5 53, +6 107

Okay, thanks. Yes, the 107 was around +6. There is a 25 minute gap between BG's. I had emailed the vet about needing to reduce his dose to prevent those low drops and haven't heard back yet. I don't think she's in the office until tomorrow, but she had mentioned that she was concerned with the drops in the 50's as well regardless if he was on 3u or 1u.
 
Re: Boy 5/1/2012 nadir & AMPS

Good to hear she is concerned, and I would have to guess when she hears he went down to 50ish today, she'll suggest a reduction. I think someone already mentioned it but it is encouraging that Boy doesn't seem to bounce badly - at least the other times he went "green". Until today, 1u was looking good. You are using U40 syringes? I'm wondering how comfortable you would be with reducing, but not all the way down to .5. Do you think you could measure "in between" with any degree of accuracy?
Won't know what to think about tonight's shot until you get there though.

Carl
 
Eyes Please +5 53, +6 107

She definitely doesn't want him going hypo and didn't want to reduce his dose too much too soon.....so reducing more was discussed. That was only this past Friday, but did send updated results to her. I am glad Boy isn't bouncing badly, or like he had been a little more than a week ago. Her feeling is that the insulin is working so well with him that the potential for the drops in the 50's is still present. Based on his numbers, she thinks his pancreas is starting to recover, but BG's still have to be done minimally at am, pm, and midday to check for those sudden drops. I just hope the diet/food/brand thing isn't messing him up too much.

I'm fine with doing a .5u with the U40 syringes, but agree that until I get his PMPS, there is no way to be sure of what his dose should be.
 
Re: Eyes Please +5 53, +6 107

Shot time is midnight eastern?
Carl
 
Re: Eyes Please +5 53, +6 107

Actually would be 11:45 pm, but I'm going to try for around 11:30......11:00 if I thought I wouldn't foul things up.
 
Re: Eyes Please +5 53, +6 107

OK, just making sure. I'll be on late tonight, no work tomorrow.

Carl
 
Re: Eyes Please +5 53, +6 107

Great.....and thanks. Day off is nice for you I'm sure too.

I did also just test him for ketones (almost positive it's his, but will double check when I hear him in the box). When changing dose times, what is the max. amount of time variance that can be done? I think I've only done a time change when there was a hold on insulin at PS. I'll be up anyway......have to watch the Flyers game first, rofl.
phi.gif
 
Re: Eyes Please +5 53, +6 107

It depends on the specifics of the curve, but an hour either way is fairly common when the situation calls for something like that.

Carl
 
Re: Eyes Please +5 53, +6 107

The time you hear 15 minutes mentioned mostly is in reference to the Lantus Tight Regulation protocol. One of the nice things about PZI/Prozinc is its flexibility and usual lack of overlap in doses. It allows you to shoot early (or late) without messing things up badly.

Carl
 
Re: Eyes Please +5 53, +6 107

Ahhh.....makes sense. Thanks for the clarification. I had remembered that the ProZinc had the advantage of some flexibility, just forgot with what. There have been times when changing his dose/test time has to be done, I just don't like doing it too much.
 
I'm thinking a little less than this morning. That way you can sleep tonight and not have to worry about Boy going too low. What is his feeding schedule from now till the morning shot?
Carl
 
I was thinking something like .6 might work well. It's just a tad more than half of what he got today, but then his PMPS number is a little bit lower too. It is very nice to see no obvious bounce from that low he saw today. Also, when they do go that low, they can be somewhat more sensitive to insulin the next cycle or two. Maybe .5 would be good too?

Carl
 
I think that would be good. I think it's better to play it safe and avoid possible bouncing, which will hopefully keep the preshot numbers down. I'm hoping you get some blues at shot times soon! That will show you that these lower doses are really working out. You're doing a great job with him!


Carl
 
Thanks....I've been glad he has responded so well. His activity level is high...and won't shut up, so I know he's feeling much better. :-D

Eating and gave .5u. Just need to make sure he eats enough or I know he'll drop tonight. I had hoped he would stay in the blue range on preshot time, but at least they haven't been huge increases. Can only wait until the next BG test value is.

Thanks so much for all of your help. It is really comforting (and informative) when others can take a look at what's going on and can give some input. I appreciate it....and I am sure others do too!!
 
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