I finally dosed Jack .6U with a PMPS of 125!! (I've been so afraid...)

[Daddy Jack's Mommy (GA)]

I finally did it!! I finally shot Jack with the same PM dose as I give him in the morning, and he only had a PMPS of 125. (And the dose is only .6). I really hope this helps to bring up his AM numbers. He's always low at night and I'm always afraid to dose him. So now... I"ll test and test again.

 

[Bron and Sheba (GA)]

Well done. Make sure you get s +1 and a +2

 

[Daddy Jack's Mommy (GA)]

Well done. Make sure you get s +1 and a +2

I just tested at +2.5, and it was 165. Is it good to test at +1 and +2, to ensure that the BG is not going down at that point? If I had seen your response sooner, I would have made sure that I tested sooner.

 

[Bron and Sheba (GA)]

When we shoot a lower than normal number for the first few times, we recommmend getting a +1 and a +2 to see what kitty is going to do. It gives you a heads up if he is going to drop low and you can be prepared and not get a nasty surprise later.
If the +2 is higher than the preshot,it usually means that the cycle is not going to do much. If it is about the same it will probably come down a bit.. if it is lower than the preshot than it will be an active cycle and you need to be alert.
Wealso recommend getting a before bed test to check kitty's BSL is not dropping too low. The same principle applies to the befor bed test and the +2 test. Does that make sense?

 

[Daddy Jack's Mommy (GA)]

When we shoot a lower than normal number for the first few times, we recommmend getting a +1 and a +2 to see what kitty is going to do. It gives you a heads up if he is going to drop low and you can be prepared and not get a nasty surprise later.
If the +2 is higher than the preshot,it usually means that the cycle is not going to do much. If it is about the same it will probably come down a bit.. if it is lower than the preshot than it will be an active cycle and you need to be alert.
Wealso recommend getting a before bed test to check kitty's BSL is not dropping too low. The same principle applies to the befor bed test and the +2 test. Does that make sense?

Thank you! That makes perfect sense now, but I was not aware of that before you explained it. Actually, now that I know that, it will put my mind at ease to shoot lower than I'm used to, because I thought I had to always wait until later in the cycle to know whether I should be concerned. It's comforting for me to know that I can get a heads up as early as +1or +2.

 

[Daddy Jack's Mommy (GA)]

Well done. Make sure you get s +1 and a +2

I've learned so much from this group, and I can't begin to tell you how much I appreciate it. I always thought I had to wait until later in his mid-cycle so I could know whether his numbers are going too low. That's the reason I'm always afraid to shoot when he's lower at night, because I have to wake up early some days to go to work. Now that I know I can really get an idea during the first or second hour, it will make me more confident to dose him in the way he should be dosed.

 

[Bron and Sheba (GA)]

Thank you! That makes perfect sense now, but I was not aware of that before you explained it. Actually, now that I know that, it will put my mind at ease to shoot lower than I'm used to, because I thought I had to always wait until later in the cycle to know whether I should be concerned. It's comforting for me to know that I can get a heads up as early as +1or +2.

Every cat is different (ECID) and it is a good idea to get lots of data until you know how your cat will react to the insulin. It is a good idea to still do a test around the +6 mark if you can just to see kitty is not dropping lower. cats like to keep us on our toes!
Also after the food at the shot time, most cats will have a bit of a food bump.....often around 50 or 100 points which often shows up at +1. So if your Kitty usually has a bit of a food bump at+1 and you test and the number is the same or a bit lower than the preshot number,than you are also getting a heads up that kitty is going to drop.
You can always steer the BSL with higher carb food if needed.
ETA food bump probably more like 40 to 50 points.

 

[Bron and Sheba (GA)]

I've learned so much from this group, and I can't begin to tell you how much I appreciate it. I always thought I had to wait until later in his mid-cycle so I could know whether his numbers are going too low. That's the reason I'm always afraid to shoot when he's lower at night, because I have to wake up early some days to go to work. Now that I know I can really get an idea during the first or second hour, it will make me more confident to dose him in the way he should be dosed.

Most cats do drop lower at night. I used to go to sleep and setthe alarm to do the testing. I didn't stay up and test unless Sheba was dropping very low and fast. If I were you I would still get up and test later in the cycle at least until you have the data to see what his usual reaction is. It is a steep learning curve which we all went on and I am still learning!

 

[Daddy Jack's Mommy (GA)]

Every cat is different (ECID) and it is a good idea to get lots of data until you know how your cat will react to the insulin. It is a good idea to still do a test around the +6 mark if you can just to see kitty is not dropping lower. cats like to keep us on our toes!
Also after the food at the shot time, most cats will have a bit of a food bump.....often around 50 or 100 points which often shows up at +1. So if your Kitty usually has a bit of a food bump at+1 and you test and the number is the same or a bit lower than the preshot number,than you are also getting a heads up that kitty is going to drop.
You can always steer the BSL with higher carb food if needed.

I don't know why I thought that +1didn't give me good info! I don't think I've ever tested him at +1 before. But now I will.

 

[Daddy Jack's Mommy (GA)]

Most cats do drop lower at night. I used to go to sleep and setthe alarm to do the testing. I didn't stay up and test unless Sheba was dropping very low and fast. If I were you I would still get up and test later in the cycle at least until you have the data to see what his usual reaction is. It is a steep learning curve which we all went on and I am still learning!

I haven't done too much testing during the night on Jack, but during the day +5 seems to be a low point for him. So maybe I'll set an alarm to test him at +5 tonight.

 

[Bron and Sheba (GA)]

I haven't done too much testing during the night on Jack, but during the day +5 seems to be a low point for him. So maybe I'll set an alarm to test him at +5 tonight.

Nadirs can move around. But if you think Jacks nadir is +5 then it is always a good idea to check around that time if you can.. all testing is good data.

 

[Bron and Sheba (GA)]

I see the +6 is 88. I’d get another test in to see that the BSL is coming up again and not down further. Always test until you see a bsl that is on the way back up.
Looking at Jacks SS he is often still higher at +2 so his +3 might be an important number for you to watch. Cats love to prove us wrong!

 

[Kris & Teasel]

I agree with Bron. Be aware that the nadir can move around. ProZinc is a bit slower in onset than Vetsulin etc. so I suggest getting a +2 when you give a dose on a lower PS. At +1 you can be dealing with the food effect and it might not give the best information.

Jack's higher AMPS could be the result of him dropping lower at night as your tests show but it can also be partly what is called "dawn phenomenon" where the metabolic processes of readying the body for waking and daytime activity raise the BG. It occurs in human diabetics as well.

I see that occasionally you've given a higher dose in the AM to counteract the higher PS but that resulted in a no shot or lower dose at night. Experience here shows that keeping the same dose AM and PM is generally a better approach. You might see slightly higher BGs overall when you first start to do that but the pattern should settle over time so that the PSs are closer in range. Right now the lower PMPS can be a sign that the AM dose is a bit too high. I suggest you select a moderate dose that can be given both AM and PM for several days in a row, numbers permitting. Maybe try 0.4 u. I'm basing that on your SS trends but it might need to be a bit lower - 0.3 u?

 

[Daddy Jack's Mommy (GA)]

I see the +6 is 88. I’d get another test in to see that the BSL is coming up again and not down further. Always test until you see a bsl that is on the way back up.
Looking at Jacks SS he is often still higher at +2 so his +3 might be an important number for you to watch. Cats love to prove us wrong!

I feel like a terrible cat mommy! After his test at +6, and before I saw your response, I went to bed for the night feeling safe. This morning, at +12.5, he was only 99. I tested again thinking it was a mistake, and he was 93. So I tested myself thinking it could be wrong, and it wasn't wrong. I test myself to monitor prediabetes and to get it under control, so I'm comfortable that the monitor was working. I have no idea how low he could have gone during the night. This is utterly nerve-wracking. So now I'm not going to dose him. I hate skipping doses, but I'm really afraid to even give him .2 right now. Do you think that's the right thing to do? For me to skip this dose? Or would it have been better for me to give him .2 and monitor all day?

 

[Kris & Teasel]

I feel like a terrible cat mommy! After his test at +6, and before I saw your response, I went to bed for the night feeling safe. This morning, at +12.5, he was only 99. I tested again thinking it was a mistake, and he was 93. So I tested myself thinking it could be wrong, and it wasn't wrong. I test myself to monitor prediabetes and to get it under control, so I'm comfortable that the monitor was working. I have no idea how low he could have gone during the night. This is utterly nerve-wracking. So now I'm not going to dose him. I hate skipping doses, but I'm really afraid to even give him .2 right now. Do you think that's the right thing to do? For me to skip this dose? Or would it have been better for me to give him .2 and monitor all day?

Definitely skip the dose. That's too low to give ProZinc. Let's see where he ends up this evening.

 

[Kris & Teasel]

FYI: there are smaller doses than 0.2 u if you need to do that later. There's 0.1 u (eyeballed) and even lower - what we'd call "a drop". You get that by pushing in the syringe plunger firmly, inserting the needle into the insulin vial, relaxing the pressure on the plunger and withdrawing the needle from the vial. That tiny bit of suction is enough to pull a drop of insulin into the needle. When injecting, you'd insert the needle subQ, push firmly on the plunger and keep that pressure on it as you withdraw the needle to prevent the drop of insulin from being sucked back into the needle.

 

[Daddy Jack's Mommy (GA)]

I agree with Bron. Be aware that the nadir can move around. ProZinc is a bit slower in onset than Vetsulin etc. so I suggest getting a +2 when you give a dose on a lower PS. At +1 you can be dealing with the food effect and it might not give the best information.

Jack's higher AMPS could be the result of him dropping lower at night as your tests show but it can also be partly what is called "dawn phenomenon" where the metabolic processes of readying the body for waking and daytime activity raise the BG. It occurs in human diabetics as well.

I see that occasionally you've given a higher dose in the AM to counteract the higher PS but that resulted in a no shot or lower dose at night. Experience here shows that keeping the same dose AM and PM is generally a better approach. You might see slightly higher BGs overall when you first start to do that but the pattern should settle over time so that the PSs are closer in range. Right now the lower PMPS can be a sign that the AM dose is a bit too high. I suggest you select a moderate dose that can be given both AM and PM for several days in a row, numbers permitting. Maybe try 0.4 u. I'm basing that on your SS trends but it might need to be a bit lower - 0.3 u?

Actually, I haven't raised his morning dose in response to a high AMPS. I have been trying to base his dose on any mid numbers that I'm getting. And I remember you suggesting before that I should be giving him the same dose two times a day, and that's what I'm trying to do. I think I'm going to follow your advice and just lower his a.m. dose as well, and see if I can't get him regulated with the same dose twice a day. But... I can't dose him at all this morning because he was only at 99. So I have no idea how low his BG went after that +6 testing. I'm quite upset right now. Do you think I should have shot when he was only 99 this morning?

 

[Daddy Jack's Mommy (GA)]

Definitely skip the dose. That's too low to give ProZinc. Let's see where he ends up this evening.

Thank you. I really wanted to make sure I was doing the right thing. I wouldn't have given it to him on my own, because I wasn't comfortable. But I feel so bad skipping his doses. I'm having the hardest time finding the right dose for him. When he was diagnosed, the vet told me to give him two units of prozinc twice a day. There was no suggestion of home testing. When I told him I'm going to test him, he told me that I need a monitor for pets. I love my vet, but he doesn't seem on board with what's going on right now. He still wants him on two units. I'm so glad I found this group and that I ignored my vets suggestion. Jack would be dead if I gave him two units and never tested him.

 

[Daddy Jack's Mommy (GA)]

FYI: there are smaller doses than 0.2 u if you need to do that later. There's 0.1 u (eyeballed) and even lower - what we'd call "a drop". You get that by pushing in the syringe plunger firmly, inserting the needle into the insulin vial, relaxing the pressure on the plunger and withdrawing the needle from the vial. That tiny bit of suction is enough to pull a drop of insulin into the needle. When injecting, you'd insert the needle subQ, push firmly on the plunger and keep that pressure on it as you withdraw the needle to prevent the drop of insulin from being sucked back into the needle.

It does seem like Jack is going to be a low doser for sure. Can you imagine if I had just blindly given him two units like his vet wanted me to? I tried that drop dose before, but I didn't do it correctly. I didn't keep the plunger in as I removed the syringe from Jack. I really don't think he got anything when I did it.

 

[Kris & Teasel]

I'm sorry if I wasn't clear. I looked at your SS and saw that on most days since, say, 15 March the dose in the AM was one number followed by either a no shot or lower dose in the PM. I based my comments on that. This short description of the recommended approach might clarify things:

• select a reasonable dose
• give that dose AM and PM for at least 4 cycles (2 days)
• get some middle cycle tests to see how low that dose drops the BG
• if the nadir range BGs are in the double digits above 50 on a human meter keep that dose
• if the nadir range numbers are consistently higher (high blues and above) increase by 0.2 u both AM and PM
• if he surprises you with a lower than usual PS you have some options that I'll outline below.

This is for a human meter:

• if close to 200 (maybe 180 and above), stall without feeding for 30 minutes and retest. If BG has risen try the full dose.
• if in the 150 to 180 range, try stalling up to an hour and if rising do the above. If BG isn't rising much give a reduced dose. How much to reduce is always a conundrum. Maybe try a 2/3 dose.
• if BG is much lower (say, 100 to 120) give token dose - size depends on what the normal dose is. It's best to avoid skipping if you can.

If you're finding yourself with a lower than usual PS on many days the dose needs to come down so the same dose can be given both AM and PM. As hard as it is, try not to react to individual numbers by changing the dose unless a PS is uncharacteristically low.

The fact that Jack's insulin needs are dropping is a good sign even though it's stressful for you.

 

[Daddy Jack's Mommy (GA)]

I'm sorry if I wasn't clear. I looked at your SS and saw that on most days since, say, 15 March the dose in the AM was one number followed by either a no shot or lower dose in the PM. I based my comments on that. This short description of the recommended approach might clarify things:

• select a reasonable dose
• give that dose AM and PM for at least 4 cycles (2 days)
• get some middle cycle tests to see how low that dose drops the BG
• if the nadir range BGs are in the double digits above 50 on a human meter keep that dose
• if the nadir range numbers are consistently higher (high blues and above) increase by 0.2 u both AM and PM
• if he surprises you with a lower than usual PS you have some options that I'll outline below.

This is for a human meter:

• if close to 200 (maybe 180 and above), stall without feeding for 30 minutes and retest. If BG has risen try the full dose.
• if in the 150 to 180 range, try stalling up to an hour and if rising do the above. If BG isn't rising much give a reduced dose. How much to reduce is always a conundrum. Maybe try a 2/3 dose.
• if BG is much lower (say, 100 to 120) give token dose - size depends on what the normal dose is. It's best to avoid skipping if you can.

If you're finding yourself with a lower than usual PS on many days the dose needs to come down so the same dose can be given both AM and PM. As hard as it is, try not to react to individual numbers by changing the dose unless a PS is uncharacteristically low.

The fact that Jack's insulin needs are dropping is a good sign even though it's stressful for you.

Thank you for all of that, Kris! I'm actually quite happy to see his lower numbers now, but it is really stressful! I think so much changed for him just with his diet change alone. I'm going to keep at this until I get his dose right.

 

[Daddy Jack's Mommy (GA)]

I'm sorry if I wasn't clear. I looked at your SS and saw that on most days since, say, 15 March the dose in the AM was one number followed by either a no shot or lower dose in the PM. I based my comments on that. This short description of the recommended approach might clarify things:

• select a reasonable dose
• give that dose AM and PM for at least 4 cycles (2 days)
• get some middle cycle tests to see how low that dose drops the BG
• if the nadir range BGs are in the double digits above 50 on a human meter keep that dose
• if the nadir range numbers are consistently higher (high blues and above) increase by 0.2 u both AM and PM
• if he surprises you with a lower than usual PS you have some options that I'll outline below.

This is for a human meter:

• if close to 200 (maybe 180 and above), stall without feeding for 30 minutes and retest. If BG has risen try the full dose.
• if in the 150 to 180 range, try stalling up to an hour and if rising do the above. If BG isn't rising much give a reduced dose. How much to reduce is always a conundrum. Maybe try a 2/3 dose.
• if BG is much lower (say, 100 to 120) give token dose - size depends on what the normal dose is. It's best to avoid skipping if you can.

If you're finding yourself with a lower than usual PS on many days the dose needs to come down so the same dose can be given both AM and PM. As hard as it is, try not to react to individual numbers by changing the dose unless a PS is uncharacteristically low.

The fact that Jack's insulin needs are dropping is a good sign even though it's stressful for you.

I'm sorry if I wasn't clear. I looked at your SS and saw that on most days since, say, 15 March the dose in the AM was one number followed by either a no shot or lower dose in the PM. I based my comments on that. This short description of the recommended approach might clarify things:

• select a reasonable dose
• give that dose AM and PM for at least 4 cycles (2 days)
• get some middle cycle tests to see how low that dose drops the BG
• if the nadir range BGs are in the double digits above 50 on a human meter keep that dose
• if the nadir range numbers are consistently higher (high blues and above) increase by 0.2 u both AM and PM
• if he surprises you with a lower than usual PS you have some options that I'll outline below.

This is for a human meter:

• if close to 200 (maybe 180 and above), stall without feeding for 30 minutes and retest. If BG has risen try the full dose.
• if in the 150 to 180 range, try stalling up to an hour and if rising do the above. If BG isn't rising much give a reduced dose. How much to reduce is always a conundrum. Maybe try a 2/3 dose.
• if BG is much lower (say, 100 to 120) give token dose - size depends on what the normal dose is. It's best to avoid skipping if you can.

If you're finding yourself with a lower than usual PS on many days the dose needs to come down so the same dose can be given both AM and PM. As hard as it is, try not to react to individual numbers by changing the dose unless a PS is uncharacteristically low.

The fact that Jack's insulin needs are dropping is a good sign even though it's stressful for you.

And I'm going to print this.

 

[Daddy Jack's Mommy (GA)]

• if close to 200 (maybe 180 and above), stall without feeding for 30 minutes and retest. If BG has risen try the full dose.

• if in the 150 to 180 range, try stalling up to an hour and if rising do the above. If BG isn't rising much give a reduced dose. How much to reduce is always a conundrum. Maybe try a 2/3 dose.

I have a problem with comfortably stalling his PM dose. if I work early the next day, it messes up his shot time before I go to work. If I stall and give it to him later, I would need to shoot before +12 - maybe as early as +10 in the AM. For this reason, I usually don't wait too long to decide how to dose him at night.

 

[Kris & Teasel]

I have a problem with comfortably stalling his PM dose. if I work early the next day, it messes up his shot time before I go to work. If I stall and give it to him later, I would need to shoot before +12 - maybe as early as +10 in the AM. For this reason, I usually don't wait too long to decide how to dose him at night.

You have up to an hour to stall with ProZinc without needing to adjust the timing of the next dose.

 

[Kris & Teasel]

And I'm going to print this.

Those are general guidelines to try until you learn more about Jack's patterns. Every cat is different - ECID!