? Hypo, 6/17 Bartholomus Overnight lows 46 for 2 hours Need advice on reduction

Rebecca & Bartholomus said:
Almost too tired to type, haven't slept tonight but he's at 46, got him up to 65 with treats and karo, now back down to 46
Please look at last night's conversation about our low numbers at night and just took two dose reductions

6/16 Bartholomus AMPS 368, +3 325, +7 104 Low PM numbers please look at SS
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Omg Rebecca I’m so sorry. Until someone with more experience can weigh in, I’ll just quickly mention Karo syrup and honey wear off quickly so you might get a more sustained boost from HC wet food (should boost bg for about 2 hours) or even dry (lasts even longer).

In case helpful this is also the hypo link that I always refer back to

Sticky - How to treat HYPOS - THEY CAN KILL! Print this Out!!

I think most important part (sounds like not applicable) is to not squirt the syrup in the kitty’s mouth if they’re having seizures. And to keep retesting every 15 mins with food.
 
Rebecca & Bartholomus said:
Hi Connie!
Just tested again and he's up to 71 now, hopefully doesn't do the drop again. The problem is he's full now. I've been giving him temptations, I think 4 times now, the karo just twice.
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So glad he’s up now!! And out of the lime greens!

Honestly temptations won’t be as high carb as high carb gravy wet food (18-20pct) or your junkiest dry food, so if he keeps dropping, I’d probably offer that next. I get it though that he’s probably a very full boy who’ll look back on today as a GREAT day.

Keep us posted Rebecca as you keep testing him! I’d just make sure to get a test after 2 hours or so, because by then all the food effects will be gone from his system.

And I’m sure someone experienced will weigh in on dosing later today.
 
Please add the date and his name to your title with some numbers so we can get you help today on dosing.
Also, please update your spreadsheet when you can, so we know what’s going on, and can advise you properly.

You’re doing a great job Rebecca! 🥰💞
 
Yes, you went from 5.25u to 5u for 4 cycles plus a reduced dose of 4.75u one cycle, a skip and increase to 5f. That’s a lot of dose hopping in such a short time especially with SLGS 😉

I’m not sure why you shot 4.75u PM 6/14. Since he’s been diabetic since last Dec, it would have been ok to shoot 5u. On PM 6/15, you skipped because he was at 74. I would have stalled a bit without feeding to see if he came up and then I would have reduced to 4.75u because he dropped below 90. But then you raised to 5f? Then you skipped again because he was below 90 (again, a stall might have helped) but didn’t reduce to 4.5u on the AM cycle 6/17.

I would definitely reduce to 4.5u the next shot. If he’s 90 or below, try stalling without food, testing every 30 mins, and shoot the rise. I’d stick with 4.5u just because he’s got a 4.75u depot going.

Moving forward, try to stall without feeding and see if he comes up so you can shoot within a two hour window. We never stall more than two hours. If, at any time, he drops below 90 again after this current cycle, reduce the dose by 0.25u.

I hope that helps. Remember, consistency is best as long as it’s safe.

Hope you get some rest.

PS: it’s not a hypo unless he’s symptomatic. Has he been? If not, it’s best to not use that term even though 40s are low on an AT.
 
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Marje and Gracie said:
Yes, you went from 5.25u to 5u for 4 cycles plus a reduced dose of 4.75u one cycle, a skip and increase to 5f. That’s a lot of dose hopping in such a short time especially with SLGS 😉

I’m not sure why you shot 4.75u PM 6/14. Since he’s been diabetic since last Dec, it would have been ok to shoot 5u. On PM 6/15, you skipped because he was at 74. I would have stalled a bit without feeding to see if he came up and then I would have reduced to 4.75u because he dropped below 90. But then you raised to 5f? Then you skipped again because he was below 90 (again, a stall might have helped) but didn’t reduce to 4.5u on the AM cycle 6/17.

I would definitely reduce to 4.5u the next shot. If he’s 90 or below, try stalling without food, testing every 30 mins, and shoot the rise. I’d stick with 4.5u just because he’s got a 4.75u depot going.

Moving forward, try to stall without feeding and see if he comes up so you can shoot within a two hour window. We never stall more than two hours. If, at any time, he drops below 90 again after this current cycle, reduce the dose by 0.25u.

I hope that helps. Remember, consistency is best as long as it’s safe.

Hope you get some rest.

PS: it’s not a hypo unless he’s symptomatic. Has he been? If not, it’s best to not use that term even though 40s are low on an AT.
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Hi Marje, thank you for the super helpful reply; I guess I went to 4.75 on the 15th because he was low again and I was afraid he would start crashing; what I didn't realize/do was I should have just been immediately lowering the whole everything by .25 on the 4th, and then potentially even again if that wasn't enough. So I caused it by not giving earned reductions appropriately. And I guess that's because the am part of his cycle was still pretty high, I wasn't thinking in terms of reduction. It's my first experience and I made a mistake. As far as the 5f, I wasn't consciously increasing, more just notating. Oh just here it's a little smidge fat. I'm really shaky and it can be pretty hard for me to get that plunger to move smoothly sometimes..even the slow twisting trick backfires on me every once in a while. So that one was just a tiny hair past the line.

I'll try to do the stalling, but just based on his cycle that probably won't work for him.
He's back to his normal numbers this morning so I'll move down to the 4.5 and see where that takes us.
Thanks for your help.
 
Rebecca & Bartholomus said:
Hi Marje, thank you for the super helpful reply; I guess I went to 4.75 on the 15th because he was low again and I was afraid he would start crashing; what I didn't realize/do was I should have just been immediately lowering the whole everything by .25 on the 4th, and then potentially even again if that wasn't enough. So I caused it by not giving earned reductions appropriately. And I guess that's because the am part of his cycle was still pretty high, I wasn't thinking in terms of reduction. It's my first experience and I made a mistake. As far as the 5f, I wasn't consciously increasing, more just notating. Oh just here it's a little smidge fat. I'm really shaky and it can be pretty hard for me to get that plunger to move smoothly sometimes..even the slow twisting trick backfires on me every once in a while. So that one was just a tiny hair past the line.

I'll try to do the stalling, but just based on his cycle that probably won't work for him.
He's back to his normal numbers this morning so I'll move down to the 4.5 and see where that takes us.
Thanks for your help.
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Thank you for the information. We all have made mistakes. I’d be rich for all the ones I made when new. We just have to be very careful about giving earned reductions.

Have you tried dosing with calipers? It will let you dose very accurately.

I’m just curious why you think stalling won’t work for him? We can always come up with a specific plan for him. But maybe what you want to do on bounce breaking days when he’s headed down is to test at +9.5 and if he’s really dropping to where you think you won’t be able to shoot, give him one tsp of LC food and see what that does.
 
Rebecca & Bartholomus said:
Hi Marje, thank you for the super helpful reply; I guess I went to 4.75 on the 15th because he was low again and I was afraid he would start crashing; what I didn't realize/do was I should have just been immediately lowering the whole everything by .25 on the 4th, and then potentially even again if that wasn't enough. So I caused it by not giving earned reductions appropriately. And I guess that's because the am part of his cycle was still pretty high, I wasn't thinking in terms of reduction. It's my first experience and I made a mistake. As far as the 5f, I wasn't consciously increasing, more just notating. Oh just here it's a little smidge fat. I'm really shaky and it can be pretty hard for me to get that plunger to move smoothly sometimes..even the slow twisting trick backfires on me every once in a while. So that one was just a tiny hair past the line.

I'll try to do the stalling, but just based on his cycle that probably won't work for him.
He's back to his normal numbers this morning so I'll move down to the 4.5 and see where that takes us.
Thanks for your help.
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Hey on Marje’s point on stalling - because I’m anxious and have stalled a bunch of times - just to confirm, she’s not saying stall until his blood glucose goes all the way back up, it’s stall to see if his blood glucose stays flat or rises from his current level without food. Assuming the number isn’t something absurdly low where you’d take a reduction.

The reason to stall without food is to confirm that the effects of the prior dose are out of his system. So if you see 95 on AMPS, stall without feeding for 20 mins and get 96, you can be pretty sure that he’s now on a trajectory up especially since you’re going to feed him. So that gives you more confidence to shoot your regular dose especially if you can monitor after. As lots of smart people here have reminded me, you’re not shooting the number in front of you, you’re shooting the number your kitty will be.

Sorry if that was obvious but it wasn’t to me when I first started so figured I’d clarify.
 
Connie & Moonie said:
Hey on Marje’s point on stalling - because I’m anxious and have stalled a bunch of times - just to confirm, she’s not saying stall until his blood glucose goes all the way back up, it’s stall to see if his blood glucose stays flat or rises from his current level without food. Assuming the number isn’t something absurdly low where you’d take a reduction.

The reason to stall without food is to confirm that the effects of the prior dose are out of his system. So if you see 95 on AMPS, stall without feeding for 20 mins and get 96, you can be pretty sure that he’s now on a trajectory up especially since you’re going to feed him. So that gives you more confidence to shoot your regular dose especially if you can monitor after. As lots of smart people here have reminded me, you’re not shooting the number in front of you, you’re shooting the number your kitty will be.

Sorry if that was obvious but it wasn’t to me when I first started so figured I’d clarify.
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Thank you. I’ve been doing this so long I don’t always stress certain points with examples. Good post.
 
You're both right. I only have a couple of data points that would suggest that; the majority, even with insulin, he is upward after a couple of hours. I'll give it a try. And Marje your suggestion about feeding higher carbs when he's looking low bound is good- I sort of did that Tuesday night, well I wouldn't give him his freeze dried after the spot check that was low, I wanted him to eat the 9% dry for the evening to bring it up a bit.

I'll have to look into the calipers.
 
Oh Gracie I forgot to ask you, what is an AT? As in
"even though 40s are low on an AT."
Actual test? I'm sorry if I'm just brain fogging here..
 
Rebecca & Bartholomus said:
Oh ok so if he were on an alphatrak and getting 40s, that would be more worrisome.
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Yep! While meters have 20 percent variance and therefore conversion between pet meters and human meters is not possible, 68 on AlphaTrak roughly equates to 50 on human (both seen as “take action” numbers). Human meters tend to give lower numbers for the same blood glucose level.
 
Connie & Moonie said:
68 on AlphaTrak roughly equates to 50 on human (both seen as “take action” numbers).
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I understand what you are saying but we try to steer away from even comparing human and pet meters. You weren’t making them equivalent, in actuality, but just stating both those numbers…50 and 68, human and pet, are numbers you don’t want to ignore. However, sometimes we get members who read but don’t post so we don’t want anyone to think there is any equivalency at all between those numbers other than they are both at the end of the “normal” range for the type of meter.
 
Marje and Gracie said:
I understand what you are saying but we try to steer away from even comparing human and pet meters. You weren’t making them equivalent, in actuality, but just stating both those numbers…50 and 68, human and pet, are numbers you don’t want to ignore. However, sometimes we get members who read but don’t post so we don’t want anyone to think there is any equivalency at all between those numbers other than they are both at the end of the “normal” range for the type of meter.
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Makes sense! Thanks for clarifying :)
 
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