Late nadirs/lowered dosing question

Lmiller86

Lmiller86

Member
Hey @FrostD
I feel like I have taken two steps back with my girl, Baby. Her dose was stable for awhile but I have felt like a complete rookie, and just plain mad at myself within the last week. She's had late nadirs quite a bit, I've been lowering doses and a few cautionary, away from home doses have left her all over the place. And, not to mention she is getting very finicky when I try to inject her. She kinda shivers and tries to move when I pull up skin. This has resulted in a few Syringes having blood on tip after injection which terrifies me. I'm getting very down on myself about all of this and I'm sure she picks up my anxiety. When you have a moment, if you could take a look at her chart, I would so greatly appreciate it!

Thank you,
Logan

https://docs.google.com/spreadsheet...H6zZui-8kM9ExM80-7rG6Gkq228/edit?usp=drivesdk
 
But how long of a needle? Just curious. Really shouldn’t have blood on them. Although it’s possible to nick a blood vessel.
 
Yes the dosing really is all over the place lol the other issue is your shot times are also too variable. Is that something within your control? Realistically they should be within 15-30 mins, though up to one hour leeway can be done for most cats...I just don't think Baby is one of them.

I think you need to go back to the sliding scale (not for lurkers we don't usually recommend this):
  • 200-249, perhaps 2-2.2U?
  • 250-299, give 2.6U
  • 300+, give the 3.2U

Obviously, reduce all of the above by 0.2U if you get a number below 90 at any time.

I would try 3 more weeks of consistency in dosing/strategy, and shot times. If this is still happening, it's time to look at switching to a depot insulin.

Are you still hesitant to ditch the dry?
 
FrostD said:
Yes the dosing really is all over the place lol the other issue is your shot times are also too variable. Is that something within your control? Realistically they should be within 15-30 mins, though up to one hour leeway can be done for most cats...I just don't think Baby is one of them.

I think you need to go back to the sliding scale (not for lurkers we don't usually recommend this):
  • 200-249, perhaps 2-2.2U?
  • 250-299, give 2.6U
  • 300+, give the 3.2U

Obviously, reduce all of the above by 0.2U if you get a number below 90 at any time.

I would try 3 more weeks of consistency in dosing/strategy, and shot times. If this is still happening, it's time to look at switching to a depot insulin.

Are you still hesitant to ditch the dry?
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Thank you for that. I am a little freaking out right now because I just read her and she's 174 at hour 1! Down from 314 and that's with dinner!
 
It looks like you brought her back up into the yellows. I know you will make sure that she stays up.

As for the 373 and 457 this morning with the same drop of blood, that’s pretty close to the +/- 20 percent meter variance that you can get with the same drop of blood.

I hope she does well tonight and that you are able to be really consistent with her shot times and doses going forward.
 
Suzanne & Darcy said:
It looks like you brought her back up into the yellows. I know you will make sure that she stays up.

As for the 373 and 457 this morning with the same drop of blood, that’s pretty close to the +/- 20 percent meter variance that you can get with the same drop of blood.

I hope she does well tonight and that you are able to be really consistent with her shot times and doses going forward.
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Thanks for your feedback. I cannot believe how quickly she went from dropping to a sharp increase. Up to 500s by hour 8. It's like her body freaked out. This is like her on Novolin. Honestly, it's very hard to feel what's right to dose at this point. I've never seen a cycle go this crazy.

https://docs.google.com/spreadsheet...H6zZui-8kM9ExM80-7rG6Gkq228/edit?usp=drivesdk
 
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A steep drop can trigger a bounce. I hope that’s all that’s going on. At least she never dropped into unsafe territory. I do understand the stress though. What did you feed her at the beginning of last night’s cycle? You should note it on your spreadsheet for future reference (the kind of food and carb percentage if you can or at least whether it was HC, MC or LC.) @FrostD What do you think?
 
Suzanne & Darcy said:
A steep drop can trigger a bounce. I hope that’s all that’s going on. At least she never dropped into unsafe territory. I do understand the stress though. What did you feed her at the beginning of last night’s cycle? You should note it on your spreadsheet for future reference (the kind of food and carb percentage if you can or at least whether it was HC, MC or LC.) @FrostD What do you think?
Click to expand...

She is on kidney food due to bad values... So it's unfortunately high carb. I'm about to start her 12 hour read and feed
 
Lmiller86 said:
She is on kidney food due to bad values... So it's unfortunately high carb. I'm about to start her 12 hour read and feed
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I understand. My boy had to go on kidney food for the same reason. It's actually not that bad. Stangely enough, it didn't really affect his BG that much, but he was acromegaly and on Cabergoline, and I always suspected that he had a working pancreas. HC food never took him up too high for too long, so I used Karo when I needed to bring him up quickly. Of course, Karo wears off quickly too. It's okay about the food, you just need to adjust the insulin to compensate. Have you ever tried the Royal Canin kidney foods. My boy liked them as well at the KD (I think the chicken and tuna vegetable stew ... or whatever that was called, was his favorite of the Hills K/D foods, but he did like several of the Royal Canin foods as well.)
 
Wow, the HC definitely affects Baby. That's great it did not affect yours! I use the RC occasionally as well. My sister is in vet school and a hills science rep, so I get the hills heavily discounted. Hard to say no to that! Now, if only I knew a zoetis sales rep lol. Going thru strips like crazy!
 
She's still at 530...gonna go ahead and feed and give her the 3.2 which was a regular dose for awhile and advised by Melissa. I'm not worried about hypo when she's 500+ I just hope it's not another sharp drop.
 
Suzanne & Darcy said:
I understand. My boy had to go on kidney food for the same reason. It's actually not that bad. Stangely enough, it didn't really affect his BG that much, but he was acromegaly and on Cabergoline, and I always suspected that he had a working pancreas. HC food never took him up too high for too long, so I used Karo when I needed to bring him up quickly. Of course, Karo wears off quickly too. It's okay about the food, you just need to adjust the insulin to compensate. Have you ever tried the Royal Canin kidney foods. My boy liked them as well at the KD (I think the chicken and tuna vegetable stew ... or whatever that was called, was his favorite of the Hills K/D foods, but he did like several of the Royal Canin foods as well.)
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Was your kitty on ProZinc?
 
Lmiller86 said:
Was your kitty on ProZinc?
Click to expand...
My boy started with Vetsulin (awful) then ProZinc (no duration), then Lantus, then Levimir. I tried them all. Lantus was pretty good, but Levemir was awesome (but he was a high dose kitty for a long time, until I got things under better control with cabergoline, which is a medication to help Acro kitties.)
 
Lmiller86 said:
She's still at 530...gonna go ahead and feed and give her the 3.2 which was a regular dose for awhile and advised by Melissa. I'm not worried about hypo when she's 500+ I just hope it's not another sharp drop.
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Have you tried feeding a teaspoon of food at +1 and maybe +2 to slow down the steep drops?
 
B
Suzanne & Darcy said:
My boy started with Vetsulin (awful) then ProZinc (no duration), then Lantus, then Levimir. I tried them all. Lantus was pretty good, but Levemir was awesome (but he was a high dose kitty for a long time, until I got things under better control with cabergoline, which is a medication to help Acro kitties.)
Click to expand...

Baby was on Novolin from Oct 2021-feb 2022 and since on ProZinc. Durations for me are so inconsistent but I feel like I'm having more trouble on ProZinc. Novolin wore off fast and I probably adjusted the dose too much but looks like ProZinc has some curve balls for us too.
 
Suzanne & Darcy said:
Have you tried feeding a teaspoon of food at +1 and maybe +2 to slow down the steep drops?
Click to expand...

She is alone for the workday day so I always leave food out for her, even if I'm here for regularity. She's pretty good about eating when she feels lowering (2-3 hr) but last night she was not.
 
Suzanne & Darcy said:
What kind of kidney values does she have? BUN CREA Phosphorus, USG? Do you give her sub-q fluids?
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Bun- around low 60s
Crea- 2.4
Phosphorous normal
Urine gravity is very poor. Not sure the rank
When we started kidney foods, the values stabilized and only went up a little after constant UTIs. Which, knock on some holy wood, she has been clear of since January.
Sub qs- 100 every other day
 
Lmiller86 said:
B


Baby was on Novolin from Oct 2021-feb 2022 and since on ProZinc. Durations for me are so inconsistent but I feel like I'm having more trouble on ProZinc. Novolin wore off fast and I probably adjusted the dose too much but looks like ProZinc has some curve balls for us too.
Click to expand...
You may want to consider a switch to Lantus or Levemir (the depot insulins) instead of a single cycle insulin. Of course, I don't know what your work schedule is, but I see that you do a lot of testing so you could probably do the TR protocol to adjust doses every 6 cycles.
 
Lmiller86 said:
Bun- around low 60s
Crea- 2.4
Phosphorous normal
Urine gravity is very poor. Not sure the rank
When we started kidney foods, the values stabilized and only went up a little after constant UTIs. Which, knock on some holy wood, she has been clear of since January.
Sub qs- 100 every other day
Click to expand...
She is very pretty! You must have been doing something right all these years to get that sweet Baby to 18! Well done!
 
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