Melville update

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ericbakes

ericbakes

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Hello, friends. I wanted to give you a quick update. Yesterday, Melville had some pretty high glucose numbers: AMPS was 346, PMPS was 399. Today is a different story.

AMPS was 158. I fed him and waited about 90 minutes to test again: 175. Fed a bit more, waited 30 minutes: 211. 2 units of ProZinc. +6 was 86, so I gave him a little more food. +11 was 126. By this time, it's dinner, so I fed him his full 30 grams.

What a roller coaster!

I'm debating on when to shoot tonight. I guess I'll stick around for 30 minutes, test, and if it's still under 200, I'll defer his shot couple hours (have to head out for a bit, so I won't be around to monitor).

What would you folks do in this situation? I don't want him to get too much off schedule, but on the other hand, I feel like changing his dosage is premature. Any thoughts?

Thanks!
Eric
 
Usually a low preshot and a longer duration means the dose is too high. I think it is time to reduce. You have a tricky situation because you fed him and food can raise bg levels. You want a " true" number to shoot, not one food induced. So you really can't trust a number for 2 hours after eating and that will throw off your 12/12. Next time, don't feed, wait 20 minutes and test again to see if he is high enough to shoot. I think I would probably skip tonight.

Even if you get a higher amps tomorrow (and you mostly will with 24 hours since the last shot) I would still reduce - maybe 1.5. See if that gives you a good nadir and a shootable pre shot. (that's the goal - nice numbers but shootable numbers so you don't have to skip or delay.)
 
Thanks, Sue. That sounds like a reasonable plan. I'll take it into consideration... we'll see how he's doing tomorrow morning.

For future reference, would there have been any benefit to doing a smaller dose at his regular time? Maybe .5?


Thank you!!
 
IMHO, it is too soon. When you have several days or weeks of numbers and have a good feel for how a given dose might affect his bg levels, you can get braver about giving a token dose at a lower preshot. But he seems to be getting general lower numbers. It is hard to know, but I think you will be generally lowering the dose.

Eric, this is why our practice is to start low and work up. Much safer to add .25 units at a time if the numbers are high than to try to figure out how much to reduce when the numbers are low. I would be very careful in the next few days, watching his nadirs especially, to be sure he doesn't dip into numbers under 40.

Can we get you to set up a spreadsheet? One night if you need help, it will be hard for people if they can't see your history of dosing and numbers. Sign onto Goggle, search Templates for FDMB spreadsheet. After you have filled it in, go over to the LH side under file and choose Publish to the Web. Use that URL in your signature. Then we can all look at his numbers.
 
All good points. I accidentally under-dosed him this morning with a partial fur-shot. Not sure how it happened, because the needle was in when I pushed the plunger down, but there was definitely some insulin on his fur. Despite this, his numbers started coming down almost immediately: AMPS 525, +2 389, +4 302. Not great, but at least they're moving in the right direction, even after feeding.

I think I'll reduce his dose to 1.5 as you recommended and see how he does. We're supposed to have an appointment at the vet, so I hope he's understanding about my non-compliance. nailbite_smile

Check my signature for Melville's charts if you're still interested. Thanks for the good advice, and Happy New Year!

Eric
 
Take your spreadsheet to the vet and show him your numbers. Surely he wouldn't want you to shoot 2 units into a 126? I would just tell him you want to be cautious and not have a hypo. And don't forget that Melville is your cat and you will be the one nursing him into higher numbers at 2 am if he is overdosed.....
 
Wow! Thanks again for this great advice! I cut his does to 1.5, and I think this may have been his best day yet! This update is divided into two sections: status update and questions, so if you're so inclined, please read all the way to the end. :)

Status Update

You can find more details on the spreadsheets in my signature, but here's a basic outline:

+11: 163 (fed 30 g and waited two hours for shot)
+13: 249 (1.5 units of ProZinc, waited 20 minutes and fed 21 g)
+3: 238
+5: 167 (wow!)
+9: 158
+11: 234 (fed 30 g)

I have a little less than an hour left before he's due for his +12 shot, so I think I'll hit him with 1.5 units again. The numbers aren't stellar, but he has spent a lot of time in yellow and blue, which seems like a good thing.

Questions
  1. If he spends a few more days in yellow/blue territory, should I consider bumping him up to 1.75 units? Or is yellow/blue good enough?
  2. If he is currently not getting the full 15 KCal/pound/day, should I increase his food if he's not begging for it?
  3. If I do increase his food, and I begin to see higher blood glucose numbers, should I increase his insulin too?

I'm trying to change only one variable and to give it time to sink in, but I'm also a little worried that he's not getting enough food to start rebuilding some of that muscle mass that he lost. I'm not sure whether my priority should be keeping his doses lower, keeping his numbers blue/yellow, or gaining weight.

Thank you!
Eric
 
I would stay at 1.5 for a few cycles. Sometimes it takes them a while to settle into a dose. Your numbers over the next few cycles should give you more info about whether you need to increase or decrease. Both are possibilities.

Are you feeding all wet Lo carb and Lo carb treats? One thing that sometimes helps is to divide what you plan to feed for the day into several small meals. The idea is that frequent feeding will help the pancreas heal. (you do want to pull the food up 2 hours before the amps and pmps so your numbers aren't influenced by food)

Have you looked at the PZI forum? Everyone there uses ProZinc. It might be useful for you to check out a few of their spreadsheets to see their patterns of dosing and numbers. Every cat is different but their experiences can help you.

http://www.felinediabetes.com/FDMB/viewforum.php?f=24

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