? kinda urgent 4/6 Kierra PMPS 144 how much insulin to give?

[Diane and Kierra]

She finally broke 100 today, got down to 69 at AMPS+5 so fed some HC. Tonight she is at 144 preshot so I am not sure how much insulin to give???? She is at 31 units. I haven't had to deal with this until now. Should I stay at 31 units or go less or go half now half later or what???

edit: I dropped it 1/2 unit (gave 30.5 units) and will be monitoring it closely tonight. I am wondering if I should have done something different. Tomorrow I can do AMPS+4 but will be gone after that until close to PMPS time, any advice as far as dosing? This is new territory for us.

 

[Wendy&Neko]

Awesome to finally see some greens!

If you are following Tight Regulation, you reduce when they go below 50. The 0.5 unit difference you did tonight will make no difference practically speaking. The depot will control the cycle. If you want to change what happens in the cycle, a half dose would do it. But I'm not sure what you want to change. She's finally getting some good numbers.

 

[Diane and Kierra]

I am afraid of her going below 50. Shouldn't I reduce it so she doesn't go below 50 rather than wait until she does?

Tomorrow I will only be around to test until AMPS+4 then I will be gone until dinner time. What is a safe AMPS bg level for shooting 31 units. I have read the tight regulation info but it is confusing to me. And isn't it different when we are at such high doses for acro cats?

 

[Suzanne & Darcy]

What time do you test and shoot, Diane? I hope you get a number that you are comfortable with this morning. Can you leave Kierra with food so she can freely eat (or do you have a timed feeder?) while you are away from home?

 

[Wendy&Neko]

And she could also bounce to the moon from those green numbers. Which looks like happened last night. He'll like be still bouncing and safe for a few cycles yet.

What is a safe AMPS bg level for shooting 31 units. I have read the tight regulation info but it is confusing to me. And isn't it different when we are at such high doses for acro cats?

No difference for TR if the dose is high. Have you ever looked at Howie's spreadsheet? A cat needs however much insulin they need. We also don't decide what to shoot based on the preshots, but rather by the nadirs.

 

[Howiesmom]

Congrats on the Greens! I remember almost tipping over when Howie hit those on Jan. 20! Trying to really understand and remember everything in TR can be a lot...I understand! As Wendy says, Kitties need what they need and it may not make any sense to us. Howie really makes no sense to me and I get frustrated quite often. It looks like Kierra’s nadir are normally around +6-8. Howie’s are usually +10-12. It took me a while to not freak out if I saw strange numbers and especially when they aren’t around his nadir. I know not being around for big chunks of the day is nerve racking and you can’t test.

Howie also earns reductions when he gets below 70 as he is on cabergoline. I use some medium carb food if he is in the high 50s through low 70s if I want to steer his numbers but not give a huge bounce of high carb food (unless he would continue to drop). Medium carb food I think is 10-15% and high carb is 18-20% (or something like that if I’m not mistaken).

Trust your gut and keep asking good questions...even if you second guess yourself like I did yesterday! Big hugs!

 

[Diane and Kierra]

Howie also earns reductions when he gets below 70 as he is on cabergoline.

If he weren't on cabergoline would you do the same? If the dose is based on the nadir but you don't know what the overnight nadir is, how do you decide on the next morning's dose? Do you use 3/10cc or 1/2cc syringes? I was looking and I didn't see any 1/2cc syringes with half-unit marks.

 

[Diane and Kierra]

A cat needs however much insulin they need. We also don't decide what to shoot based on the preshots, but rather by the nadirs.

She did go back up so no more greens. What testing schedule do you suggest so I can get a better idea of her nadir? I feed at shot time and mini-meals at +3, +6, +9. I was worried about her weight gain lately but the vet said her weight is good.

 

[Wendy&Neko]

Testing schedule would vary based on how much she's dropping from PMPS. If you get a +3 that is around the same or above PS, you don't need as much testing. If you see a big drop for that first test, test more. I also wouldn't test, get a green number, then stop testing the rest of that cycle. As she gets closer to greens, the mean time between tests shortens. Nadirs can vary by cycle too.

 

[Howiesmom]

If he weren't on cabergoline would you do the same? If the dose is based on the nadir but you don't know what the overnight nadir is, how do you decide on the next morning's dose? Do you use 3/10cc or 1/2cc syringes? I was looking and I didn't see any 1/2cc syringes with half-unit marks.

I use 3/10 syringes as that is what we’re used to. Since Levemir keeps Howie pretty flat (compared to Lantus) and his nadir is a lot of times at PS, I take a chance/risk that an earlier nadir is not going to be much different. He also gets 3 mini meals throughout the night in an auto feeder to keep him a little better regulated. When he first was hitting greens, I was testing more in the middle of the night if he was dropping too low but that was wreaking havoc on my body as I can’t fall back asleep. But that was before Wendy recommended I move his reduction # to 70 instead of 50. So do I take a risk that he might drop really low and I don’t catch it....yes. But it’s just me taking care of him and working full time, so I do what I can do.

 

[Diane and Kierra]

So do I take a risk that he might drop really low and I don’t catch it....yes. But it’s just me taking care of him and working full time, so I do what I can do.

I get that - the caretaker has to be in good shape to be the caretaker! For the past going on six months my sleep schedule has been whacked and half the time I feel like mush brain. Interesting that Howie's nadir is often at PS. I am going to do more testing in the earlier and later hours post PS. I think Kierra's curve is often flatish.