How to shoot OFF-TIME doses

Status
Not open for further replies.
AndreaM

AndreaM

Member Since 2010
Hi Everyone,

I have a few day/evenings coming up where it will not be possible for me to give PM shot on time. What is the protocol for dosing Lev off-time?
Is it better to have a neighbour come over an give a reduced on-time shot and then I give the remainder when I get home? She would not feel comfortable BG testing.

For example, Saturday could go 2 ways right now. Normal am & pm shot times are 8:00. I shoot and then feed. I may need to leave the house at 3:30 and not be home until about 11:00. 2nd possiblity is that I have to leave at 6:30 and not be home until 11:00. How should I proceed?

Thank you,
Andrea.
 
Are you worried about low numbers on a regular dose when you are not there? If your neighbor can shoot at 8pm, and you are not worried about the numbers, have her give the regular dose or a slightly reduced one, but do not give any more insulin when you get home. Just give the reg dose at the next reg shot time (8am Sunday).

Or, you could shoot a reduced dose at 8am Sat and a reduced dose at 6:30pm Sat. Then reg dose at 6:30am Sunday and begin to move the shot back to 8a/8p in half hour increments.

Vicky might have some thoughts on this - she is the "off schedule shot" specialist :-D
 
AndreaM said:
Hi Everyone,

I have a few day/evenings coming up where it will not be possible for me to give PM shot on time. What is the protocol for dosing Lev off-time?
Is it better to have a neighbour come over an give a reduced on-time shot and then I give the remainder when I get home? She would not feel comfortable BG testing.

For example, Saturday could go 2 ways right now. Normal am & pm shot times are 8:00. I shoot and then feed. I may need to leave the house at 3:30 and not be home until about 11:00. 2nd possiblity is that I have to leave at 6:30 and not be home until 11:00. How should I proceed?

Thank you,
Andrea.
Click to expand...

Hi Andrea,

If you can start tomorrow and move the shot time to 9 AM/9PM, that would help. To do that you would give 1/2 the regular dose at 8AM then give the other half at 9AM. The 9 PM shot would be a full dose.

Then Saturday you again split the dose in half, give one half at 9AM, the other half at 11AM. That extends the duration to 11PM and a full dose would be given at 11PM.

You can do split doses like this 3 hours apart, but that's pushing it. 2 hours apart works best in my experience.
Peggy & Mickey use this approach and it works well for Mickey. He is doing very well right now.

When do you need to get back to the 8AM/8PM shot schedule? I can help you with that too and it requires reducing doses because you would be giving shots at +10 or +11.

Hope that helps!
 
Ah, just looked at Schroeder's SS.

I have some concerns. One is that it looks like he may be getting a bit too much insulin based on the lows from the 26th followed by the highs the next day. Also, you are changing the dose too much based on PS readings and schedule and that doesn't work well with lev. You can make some scheduled changes with a good plan, but caution should always be the driver on that.

Suggestions: lower his reg dose to 3u and don't mess with it for 3-5 days if at all possible. (I know you have that off schedule Sat, but otherwise, don't change it unless he gives you a really low PS number like he did on the 26th).

For schedule oddities it is important to not shoot a combined dose that is more than his reg dose - I am looking at the 4u total on the 29th. And when you have to shoot sooner that +12, you need to reduce the shot previous to the early one PLUS the early one. On the 29th it would have been better to just wait until 8:30pm and shoot the reg dose. Then you could have shot at 8am the next morning and not worried about it.

For moving shots earlier, reduce the reg time shot before hand and the early shot. The next shot should be 12 hrs after the last shot. Example: you need to shoot at 6pm instead of 8pm. That morning at 8am, shoot a reduced dose and at 6pm shoot a reduced dose. The next shot is at 6am the following morning.

When moving later, you can "extend" the cycle by using split dosing. This works by shooting half the regular dose at the regular time and the other half at the later time for the cycle before you need to shoot the late one. Then the late shot is 12 hrs after the second half dose. Example: you need to shoot at 11 pm one evening so that morning you shoot half the dose at 8am and half at 11 am. Then the reg dose at 11pm. The next shot needs to be at 11am the following morning. If you can't shoot late the following morning then the 11 pm shot and the 8am shot need to be reduced.

It is always better to be cautious and shoot less if you are unsure, don't have data to show how he will react, etc. Better to spend a few days getting him back on track after a day of too little insulin than risk a hypo when no one will be there.

Questions?
 
Yep, yesterday was Rebound City! Sorry I didn't have time to look at spreadsheet last night.

Shooting that 1U early is what caused it most likely, as he's doing very well on 3.75, but Sheila is probably right as that 59 occurred kind of early for Lev, so 4U is probably a tad too much, but how much too much we can't be sure yet.

I'm not sure about dropping back to 3U though 'cause he's at a precarious point right now. He easily has high numbers on less insulin, but yesterday had to be a rebound. How much earlier did you give that 1U? And if he needs some EVO, he's going to need more insulin. You didn't put on spreadsheet when you took up the EVO, but I'm wondering if these greens and blues the past few days aren't because of its removal.

She is right about not changing the dose so much. Lev needs some time to settle, so it's still difficult to know what the best dose for him is right now. My impression from numbers so far is that it's probably 3.75U but until it's held for 3-5 days, we aren't sure. And the other thing about these stages is that working up to a good dose can often result in a quick turn-around and require dose decreases. Doesn't mean you overshot the dose, it just means the process is working!

I feel for you about the food issue and as discussed before, it's an important part of the equation. It's hard with more than one cat. I used a timed feeder for Gandalf and he quickly learned when it would go off and he would wait for it, even try to influence it to open! It took a long time for my other cats to catch on and he would get his food without them bothering it.

Can Schroeder still jump very well? Gandalf could not, so I was able to keep food for my other cats out of his reach, that may be a possibility for you. If you feed Kane the EVO out of Schroeder's reach, maybe that would keep Kane preoccupied enough to not bother Schroeder's food.

Hang in there. I think you could do the split shots based maybe on 3.5U instead of 4U, just to keep him from rebounding again. Basing split shots on too high of regular dose can create too long of duration and unshootable numbers when you need to shoot.
 
I need to get back to 8am by Monday. 8am is the absolute latest I can shoot on weekdays before I have to leave for work. This translates well to weekends when I don't want to get out of bed before I have to!

I will try the split dosing if I can't get my neighbour to come over. The reason I suggested a slightly reduced dose if my neighbour could do it is that Schroeder isn't stablized yet and she would be shooting blind. I'd prefer to err on the side of caution.

The food thing is such an issue. Kane is a pig. He will eat everything in sight, including Schroeder's food. I wish I could find a LC Dry food that is not so high in calories, cuz Schroeder is beginning to look a little pudgy which means he's been the one indulging in the EVO, probably because Kane ate all his wet food.... Schroeder and Kane both get around great and can jump up, so I can't hide food up high for either of them. Works great though when the dogs come to visit!

I thought I'd been pretty good about keeping the Lev dose steady over the last couple weeks (except for this Wed when I shot 1 unit early - I thought I was going to be later coming home than i was, so I gave him the rest of the dose). 3.75 does look like that's where he's most comfortable. Good numbers this morning, so I dropped it from 4 back to 3.75, and yes there is EVO down.... Won't be home until just before 8 tonight and needed to make sure Schroeder had something to each if he dips low.
 
I don't know if you would want to go to the trouble of making a special box that only Schroeder can get in to, but I found the instructions online the other week and posted them on Health.

http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=63851

If you need to get shot time back to 8AM by Monday and can do changes over Sunday, you could shoot 3U at 9:30AM Sunday if the Saturday night shot was at 11PM, stay with 3U at 9:30 PM Sunday night, then shoot 3U Monday morning at 8AM. That scenario probably would result in a safe to shoot preshot on Monday morning. Stay with that 3U also for the 9:30PM shot to prevent the MOnday 8AM preshot from being too low.

I reduced 3.5U by 15%, which is .5U, to arrive at the 3U dose. I thought with this large of dose 15% reduction would be adequate. If you're not sure, you can lower it more, but it should probably not be less than 2.5U, we don't want to lose too much shed.

You would go back to 3.75U if you're comfortable with that dose then Monday PM.
 
Status
Not open for further replies.
Back
Top