Frodo's bouncing all over the place . . .

Status
Not open for further replies.
H

heidi

Member Since 2012
Hi, everyone.
I hope to eventually become a regular poster on this board, but the last two weeks have been so stressful . . . And the roller coaster keeps rolling! Frodo went hypo with symptoms on Monday at the 0.5 unit dose (I posted on the main board -- thanks for your suggestions!). I took him off insulin for two days to see what would happen and his numbers went high and kept climbing. I decided to start him back up at 0.25 units 2 x day, but his numbers have been all over the place since (pre-shots ranging from 129 to >600). I believe the problem may be me. 0.25 is such a small dose and it's so hard to be accurate and consistent, especially since I'm so new at this. I asked for advice on the "tight regulation" board about low doses and got some good advice, but I'm still struggling. From just the little data I've collected so far (I've had a very busy week at work and school), it seems like he goes very low, very fast when I err on the high side -- maybe 0.3 unit. And the insulin seems to have no effect or little effect when I err on the low side (more like 0.1). Does this interpretation seem realistic to you? My other idea is that on this low of dose, maybe his eating patterns and schedule have an even greater affect on blood sugar? I'm hoping to monitor a little more closely this weekend and get some more data.

Would love to have some ideas. I'm completely stressed out thinking that such a tiny difference in dose could have such profound effects on his blood sugar.
Thank you,
Heidi and Frodo
 
Hi, Heidi ~

Gosh, I wish this could be easier for you and Frodo. I do know how challenging microdosing can be, Heidi. I wear trifocals which seem more of a hindrance than a help when I'm trying to draw a microdose. We bought a syringe magnifier which has been a big help to me. Are you using a Lantus vial or one of the pens? The particular magnifier that we have fits onto the vial, but I believe there may be other magnifiers that fit over just the syringe. Maybe someone on this board will know or you could ask on the Main Health board, too. I think I read about a member using some kind of a sewing magnifier to help her dose.

"it seems like he goes very low, very fast when I err on the high side -- maybe 0.3 unit. And the insulin seems to have no effect or little effect when I err on the low side (more like 0.1). Does this interpretation seem realistic to you?" Yes, for some cats, a tiny microdose of Lantus can make a large difference in bg numbers as you're finding out with Frodo, Heidi. I do think consistency is important in microdosing as Sienne has mentioned. What you're considering to be a .20U dose might not be the same as my .20U dose, but your .20U doses should always be as close to the same dose as you can get them (much easier said than done, I know). Using apple juice, I draw up my microdose into a syringe, checking it with the magnifier. I keep that apple juice syringe for comparing with my microdose Lantus syringes. That does seem to help me, Heidi.

Let's see what other members suggest. I'll send messages to a couple of other members to see if they can help.

Hang in there,
Eva
 
Thanks, Eva. I like the idea of filling a syringe or two with a colored liquid to keep on hand as a dose comparison tool. I'll have to look into getting a magnifying glass of some kind. My mom might have a sewing one that I could borrow to see if it would help. I don't wear bifocals yet and just got my eyes checked last month, but I swear I can't see the difference between .1 or .2 or .3 . . . I've only been telling myself "a little light" between the o.o mark and the plunger, but even that is a little subjective each time. At least I have a weekend to get some materials together and try to practice a bit.

Thanks again,
Heidi
 
heidi said:
Hi, everyone.
I hope to eventually become a regular poster on this board, but the last two weeks have been so stressful . . . And the roller coaster keeps rolling! Frodo went hypo with symptoms on Monday at the 0.5 unit dose (I posted on the main board -- thanks for your suggestions!). I took him off insulin for two days to see what would happen and his numbers went high and kept climbing. I decided to start him back up at 0.25 units 2 x day, but his numbers have been all over the place since (pre-shots ranging from 129 to >600). I believe the problem may be me. 0.25 is such a small dose and it's so hard to be accurate and consistent, especially since I'm so new at this. I asked for advice on the "tight regulation" board about low doses and got some good advice, but I'm still struggling. From just the little data I've collected so far (I've had a very busy week at work and school), it seems like he goes very low, very fast when I err on the high side -- maybe 0.3 unit. And the insulin seems to have no effect or little effect when I err on the low side (more like 0.1). Does this interpretation seem realistic to you? My other idea is that on this low of dose, maybe his eating patterns and schedule have an even greater affect on blood sugar? I'm hoping to monitor a little more closely this weekend and get some more data.

Would love to have some ideas. I'm completely stressed out thinking that such a tiny difference in dose could have such profound effects on his blood sugar.
Thank you,
Heidi and Frodo
Click to expand...

hello Heidi,

It's looking like Frodo's doing his own imitation of a frog, hopping all over!

OK a couple things first.
1. Lantus does NOT like dose changes all over the place and does better with some consistency.
I don't know how you are measuring your doses, but it would be good if you can get a .1u dose steady for at least 2 full days to let the dose settle, even if it means Frodo is in high 200s or something.
What you are wanting to do is let the dust settle and see where you stand.
If you find that the .1u is stable but a wee bit low, you can try to go up to .2u BID.

Are you doing the twist drop method of measuring? I don't know about you, but when getting down to drops, you need a method that is going to give you as close to the same amount each shot.

You may want to practice that small of a dose which is easy.
Take a used syringe, draw up .5u in water, then twist the plunger to push out one drop at a time.
Ultimately, you want to get to the point where you are able to squeeze out 5 drops from that .5u.
I tried it a couple times but since my cats are acro, there's not ever going to be a time when I will be giving that teensy of a dose!

Just keep practising until you can get your twists so that you get about 4 drops or maybe even 5drops per .5u of water. It may not be the method you are using or others gave to you, but hopefully it will help you calm down Frodo's numbers.

2. Food spacing and amounts can also help you with balancing the numbers. If you are seeing drops at certain times, try giving a small snack or mini-meal at those times to slow the drop. By slowing the drop, you have less chance of bouncing later.

3. Dosing pretty much needs to be every 12 hrs. it will be easier on Frodo to have level numbers, even if they are a shade higher... they will be better than the extremes of 30s and 500s, that's for sure!

4. if you are busy, life has a way of happening to all of us, it's better to err on the safe side with dosing, so don't stress - just go with the .1u for a bit as it will be safer and you won't be so worried.

give it a try and ask if you have any questions.
 
Hi, Heidi and Gayle ~

"Are you doing the twist drop method of measuring?" -- You know, I've had that twist drop method described to me before, but for the life of me, I can't "twist" a drop out of a syringe...way more than that goes out. Are some brands of syringes better for doing that than others? Wish someone could give me a demo...I'm such a show me type person :-D .

Heidi, this is the syringe magnifier that I've been using: http://www.amazon.com/Becton-Dickin...e-Box/dp/B000DZHCM6?tag=felinediabetesfdmb-20
That particular one is designed to be used with a vial of insulin and the syringe. I do think a magnifier of some kind could help you with microdosing. Heidi, my husband said he thinks a desk magnifying glass on a stand would work well for microdosing, something like this one he gave me the link to: http://www.amazon.com/SE-Table-Magnifier-Lamp-Fluorescent/dp/B000OGU87A/?tag=felinediabetesfdmb-20.

Gayle, thanks for giving Heidi some good ideas about dosing and feeding. I like Gayle's idea, Heidi, of going with that tiny .10U dose AM & PM to start out so you're not so worried about Frodo's going too low.

Hang in there, Heidi. I know you'll get this figured out for Frodo. And we'll all hang in there with you.

Hope you have a relaxing evening.

Eva
 
Heidi, what brand of syringes are you using?

I just had my husband, who's very adept at microdosing, spend some time with me twisting drops out of different brands of syringes we have on hand. We have just received some Monoject syringes (30 gauge- 3/10cc - 5/16" needle) that we'd ordered, and they're by far the best of the ones we tried for drawing tiny, microdoses of insulin. What I really like about them is that the lines on the syringe barrel are so much finer than on the other brands, making it much easier to read a tiny dose amount.

If you're not already using Monoject syringes, Heidi, my husband said we can mail you a packet of them to try out to see if like them. Just let me know.

Eva
 
Thanks, Gayle and Eva.
I'm using the 31 guage BD 3/10ml. syringes. I started at 0.5 and tried twisting out a few drops this evening and kept getting one drop that just got bigger and bigger until I'd pushed out all the insulin. Wow, 0.5 u is not very much is it?

I ended up having to push out a tiny drop, then flick it off. Push out a tiny drop, then flick it off etc. I keep getting 4 of what I call tiny drops in the 0.5 u, not five which would be so much more convenient. I guess if I can learn to be consistent about always getting 4 drops from 0.5 units though, I can just use these as my potential doses, right? I can think of his dose as 1 drop (.12), 2 drops (.25), 3 drops (.37) or 4 drops (0.5), whichever one we may eventually regulate at. Then I don't need to read the syringe except to get it to the 0.5 mark which I can handle. Thank you, Gayle! That's brilliant! It seems like a very workable way to do this. I'm going to keep practicing until I either figure out a way to do 4 (or 5) drops consistently, then I'll start him back on 1 drop 2 x day and start over with the start (very) low and go slow protocol.

Thanks. I'm feeling much more confident I can handle this. BTW, my mom is bringing over a couple magnifying glasses tomorrow, so I should be able to test that too as a possible way to get this micro-dosing under control.

Thank you again for taking so much time to help Frodo and I. Obviously he isn't as upset as I have been. My former fat cat, now almost healthy weight cat, is frisking around with the younger cats right now -- I haven't seen him so playful in years. It really makes me happy to see him romping and having fun, despite being 13 and an unregulated diabetic!

Heidi
 
"Obviously he isn't as upset as I have been" -- If our kitties only knew how much we go through for them, Heidi :-D . It's so good to hear that Frodo's frisky and playful now.

With all the syringe twisting we were doing, we (well, my husband) were only able to get 5 drops a few times. Usually 4 drops. And I think 4 drops are fine as long as they're consistent for you, Heidi. Did you do 2 drops (.25U) for Frodo last night? Will be interesting to see what his AMPS numbers is today. Just takes time on a consistent dose to start seeing better numbers.

Hope you have a good weekend with your kitties, Heidi.

Eva
 
Hi, looking over your Ss I see you transitioned to low carb wet food. And then have this huge decrease in insulin, but still still bouncing all over the place even on a small amount of insulin.

Bounces take 72 hours to clear, but what concerns me is your nadirs appear way low. And the constant fiddling with the dose doesn't help to interpret what is going on, but...

I am almost ...almost wondering if your Frodo is actually "broken" to diet controlled and the bounces and high numbers are being protective because Frodo doesn't need the insulin?

I am going to see if I can get some other eyes on your SS who have more experience with this. So just sit tight and work on that twisting method. I have seen many cats who just need a drop of insulin.
 
Looking over Frodo's spreadsheet I have the same wonder of Beth that Frodo might be diet controlled and that higher number that you saw the one time you took him off insulin was the result of a bounce off that 22 the day before.

The easiest way I have found to give those "inbetween the marks" doses is if say you are shooting 1u you would line the bottom edge of the plunger with the bottom of the 1u line. So If you need to shoot a .75u you line the top edge of the plunger with the bottom of the 1u line. With bottom being defined as towards the needle. But this only works until you get down to needing a dose below .25u after that you have to switch over to the drop method. However, while I have practiced that twist a drop method, luckily I have never really had to do it. Maxwell went OTJ off a .5u :-D and Musette is still well above needing that refined of a dose. :lol:

If you wanted to try Frodo off insulin to see if he might already be OTJ you may need to hold it for several days just like you would a new dose of insulin to let it settle. Not only can a bounce take up to 72 hours to clear, but also just like you had to fill up that shed, you are going to have to let it drain before you can truly see how Frodo is doing on strictly diet controlled. But if you do take him completely off check him as often as you can for ketones especially if his numbers stay up there for a day or two.

I think if he was my cat I would try him off insulin, but hold it for several days to let any bouncing clear and for his shed to drain. Now Musette is a DKA survivor so with her I would be stalking her everytime she looked at the litter box, if Frodo isn't prone to ketones then spot checks when you can are fine, just whenever you can get a sample of urine to test.

Mel, Maxwell, Musette & The Fur Gang
 
Hi, Heidi, Beth and Mel ~

Beth and Mel, I think you've made some good points. On 2/1, a .25U dose brought Frodo down from 577 AMPS to 129 PMPS...and that's after 3 skipped shots. Heidi, I believe you did note on Frodo's spreadshee that you weren't sure of that dose amount, that it could have been a higher amount. But the puzzling thing is that you've gotten higher, flat numbers since then with very small doses of insulin. Some bouncing maybe, but that pattern could mean that Frodo needs just a tiny dose of insulin or it could mean he's getting too much insulin. We're going through something similar with Butters now. We try fattening a dose, and his numbers go higher, flat until we skinny the dose and his numbers drop again. Amazing what just a tiny drop of insulin can do.

"If you wanted to try Frodo off insulin to see if he might already be OTJ you may need to hold it for several days just like you would a new dose of insulin to let it settle." -- Heidi, this would be exciting for you to try, as Mel's suggesting. In the meantime, I know it's hard to you to see those higher numbers for Frodo, but you'd need to wait them out for a few days to see if Frodo's numbers start dropping.

And, heck, you're going to be an expert at twisting drops out of a syringe :-D .

Eva

P.S. Heidi, I forgot to add that I think it might be easier to take Frodo off insulin for a few days to see if he really needs insulin than continuing to microdose and trying to figure out if he's getting a slight overdose. As Mel's mentioned, testing for ketones will be important since Frodo's numbers are likely to be high for a period of time.
 
There is just not enough tests at nadir to judge this. I see the 600+ reading, but that is likely a bounce from something that happened overnight.

I am seeing

1/30 ....all greens with potential hypo
1/31 ....would have been all bounce
2/1.... the 577 is still the bounce, but to low of 129= no shot. Don't know if that 129 was rising up from a low during the day or falling?
2/2.... bounce from some low number on 2/1
2/3....bounce from 2/1 which that timing of the high+600 is about the same at the 577 from the 1/30 low.

My gut is telling me there is too much insulin, but I just don't have the "facts" to advise properly.

If it were me, I'd go to 0.1u and stay there for a week. Make a solid attempt to get at least 4 tests a day. Pre-shots and at least one nadir(+4-+6) per cycle.

Syringe fine gradations
 
Heidi, just checking to see how you are doing with Frodo.

It may be tough in the start to get that .1u dose, and I bet it feels like you gave nothing, but the BG numbers will tell you how you and Frodo are doing.

Don't worry about getting lots of tests in as work and school are taking up most of your time now.
So long as you test before each shot to be sure it's OK to give a shot, that will have to do till you have a free day to test more or do a curve. With such a small dose of .1u, I don't think you will have to worry about going too low, provided you don't shoot a low ps number, OK?

Here in RL, many people just are not able to do all that would be ideal, so we just pull together to make the best of what we can. Maybe see if you can get a before bed test as it will let you know if Frodo is planning to dip low at nite.

I am hoping that once his numbers level off, at whatever level, Frodo will start feeling better as those big ups and downs are pretty hard on him.
 
Maybe Frodo's AMPS number this morning will tell a little bit more? I believe Heidi dosed 2 drops last night.

If you decide to do the .1U dosing, Heidi, sounds like you're getting the syringe twisting, drop counting down to a fine art :-D . You'd dose 1 drop twice a day. Such a teensy amount of insulin can make a real difference in some kitties...like Frodo maybe.

Eva
 
Right now I can't make heads or tails out of Frodo's information. We need some near nadir testing happening as that is where the dosing decisions come from whether one is TR or Relaxed. We can't tell right now if those pinks/blacks/reds are bounces or reflective of too little insulin.
 
When in doubt, step back from the dosing.

Sometimes, if you are working AND going to school, it's pretty tough to get the tests done that would be ideal. That's life. There are several people who work many days, long hours, 12hour shifts, and just can't do the TR way. It is for that reason the RL forum exists; to accommodate those who are trying to the best of their ability.

With the change of food, and the bouncing around of dosing which was also being dropped due to positive diet changes, I think it's a good idea to go right down to the .1u dosing and letting it settle.

It will take a day or two for the dose to settle, and Heidi can try to get some testing done around nadir or maybe even a curve when she has a free day so we can see how the reduction is working.

I have to applaud Heidi for managing work, school, and also caring for her diabetic cat; many people with less full lives couldn't bother even trying, and my Oliver who I adopted is a good example, was from such a couple who surrendered him to the vet for PTS because the diabetes was too much bother.

See what you can do, Heidi, to get the odd test or two along the cycles, and the bedtime one is good if you can. Many cats do not have nadir around mid cycle, mine are around +4 and +11, so any test you can squeeze in is good data. A +3 or +9 or even a +1 or 2, they are all helpful.
 
Hi, everyone. Thanks for your suggestions! One of my 3-year-old twins has the stomach flu, so I wasn't able to get on the computer this morning to check your ideas before dosing this morning. Last night I practiced on the drop method and was getting pretty consistent at getting 4 drops each time after pulling the plunger to 0.5. Since I had been giving him what I thought was about 0.25 (or at least trying to) for the past few cycles, I gave him two drops last night and two drops again this morning (0.25 u based on 4 drops in 0.5 u). I did get an AMPS (244) and a +3 shot (204) this morning and the numbers are much less alarming.

From what I understand from your suggestions, I've got three options at this point. I can stay at the 0.25 for the next week. I can drop to 1 drop (0.12 u) for the next week. Or I can take him off the insulin for the next week (or at least 5 days). The 0.25 would have the advantage of consistency since I've already started there. . . Also, I'm feeling much more confident about my ability to dose consistently at this level. But I'm willing to go with one of the other recommendations. I believe I could be pretty consistent with the 1 drop also and I'm willing to try to test for ketones if we go off the insulin (I have the strips but haven't used them yet).

You are right--I came to the relaxed lantus board because as much as I'd like to be consistent with testing, it just isn't going to happen in my single mom, twin boys, school and work universe. I can get a few more mid-cycle tests in this weekend and a few evening tests this week. That way we'll have a little more data to work with.

Thanks again. I sure appreciate all your help.

Heidi
 
Gayle Shadoe & Oliver said:
When in doubt, step back from the dosing.

Sometimes, if you are working AND going to school, it's pretty tough to get the tests done that would be ideal. That's life. There are several people who work many days, long hours, 12hour shifts, and just can't do the TR way. It is for that reason the RL forum exists; to accommodate those who are trying to the best of their ability.

With the change of food, and the bouncing around of dosing which was also being dropped due to positive diet changes, I think it's a good idea to go right down to the .1u dosing and letting it settle.

It will take a day or two for the dose to settle, and Heidi can try to get some testing done around nadir or maybe even a curve when she has a free day so we can see how the reduction is working.

I have to applaud Heidi for managing work, school, and also caring for her diabetic cat; many people with less full lives couldn't bother even trying, and my Oliver who I adopted is a good example, was from such a couple who surrendered him to the vet for PTS because the diabetes was too much bother.

See what you can do, Heidi, to get the odd test or two along the cycles, and the bedtime one is good if you can. Many cats do not have nadir around mid cycle, mine are around +4 and +11, so any test you can squeeze in is good data. A +3 or +9 or even a +1 or 2, they are all helpful.
Click to expand...

Gayle I am so glad you agree with my suggestion to step back from dosing.

Heidi, I appreciate your efforts to get some mid-cycle testing as those low numbers are how we safely make dosing decisions and dose change recommendations. Yes all our days can be very, very busy. My day typically starts at 4am and ends about 10pm. You will see there are days I do a BCS...big chicken shot...just because I won't be around and you will note I don't typically like to run Atlas below 100 because my schedule is so very wonky. Add on to that ...Attie is one of those late nadir demons too! ohmygod_smile
 
Hi, Heidi ~

Sorry to hear one of your twins has the flu. Hope your little one is feeling better soon.

Heidi, I hope we're not driving you nuts with our different suggestions. :-D Since Frodo's a bit of a furry challenge for you. we've just been brainstorming to come up with some ideas for you.

"The 0.25 would have the advantage of consistency since I've already started there. . . Also, I'm feeling much more confident about my ability to dose consistently at this level." -- Based on your 244 and 204 numbers this morning and assuming Frodo doesn't drop steeply in a few hours or by PM preshot today, Heidi, then I'd go with the .25U that you're feeling confident about shooting. As you noted on Frodo's spreadsheet, maybe you were shooting more than .25U before you started the drop method of measuring. Since you're going to be around to test Frodo a bit more today and tomorrow and you've already started the .25U dose, Heidi, this might be a good time for you to try the .25U dose to see how it works for Frodo. One concern I have is that Frodo was at 511 at PMPS last night and dropped to 244 at AMPS this morning on the .25U dose. Could be bounce clearing, but I'm just not sure. Frodo certainly shows a lot of action on a very small dose of Lantus. Something you're already quite aware of, Heidi, and will be watching out for, I'm sure. If you need to drop him down to the .10U dose, you'll be ready.

Let's see what others suggest, Heidi.

"it just isn't going to happen in my single mom, twin boys, school and work universe." -- I think you're doing great, Heidi! I admire you for taking such good care of Frodo with all you have going on in your life now. Just reading your sentence makes me think I need a nap :-D ...don't know how you get everything done.

Eva
 
I appreciate the different suggestions, Eva. It gives me different possibilities and lets me know what to look for or what might be going on.

Today's numbers (all low 200's with a PMPS of 503) suggest to me that Frodo hasn't been dipping too low and bouncing back up (when he's gone low in the past, he's stayed down there for a long time). I'm going to get another test at +2 tonight and test again tomorrow at least 2 or 3 times mid-cycle. If the numbers are relatively consistent with today's numbers, then I think holding this dose for a week is probably the best plan, with a mid-cycle test thrown in whenever possible and maybe a curve next Saturday.
 
Good Morning, Heidi ~

Sounds like you have a good plan for Frodo. And, Heidi, you already have the experience with him to know that you can always reduce the dose to .10U or skip the dose if his numbers drop too low for you to be comfortable shooting the full .25U.

Will be interesting to see what kind of numbers you get for your sweet furguy today.

Hope your little son is feeling better today, Heidi.

Have a relaxing day.

Eva
 
Status
Not open for further replies.
Back
Top