Midnight's blood sugars updated

[TMR]

I posted on the general board recently, but I thought I would also check in here. I am not quite sure what to do because her blood sugars are kind of all over the place. I am debating between 0.5, 0.75, and 1 unit. I supposed 1 unit is probably too much. There are very few days when I can get a midcycle reading, but I am trying to get more of those. Any thoughts on dosing?

Also, she is having loose bowel movements, ever since diagnosis. She has been on 3 different foods (Purina DM, EVO, and Raw Instinct--all dry), metamucil, and fortiflora and none have helped. Wet food made her throw up and have even worse diarrhea. I am taking her to the vet next week. Maybe he will try flagyl or immodium. Any ideas?

 

[Deb & Wink]

I am not quite sure what to do because her blood sugars are kind of all over the place.

Well, it's at least partly a factor of your dosing being all over the place too. As well as some skipped shots. And Midnight is probably dropping low overnight.

Here's an example.
She goes too low for you to feel comfortable for you to shoot so you skip. (6/11 AM)
She bounces because of the missed shot. (6/11 PM)
She bounces more overnight, drops low on 6/12 and bounces high again at mid cycle.
She drops real low again on 6/13 +6 and liver panics and pumps out hormones to shoot her back up.
She drops low again overnight on the 6/13 and is low at AMPS on 6/14.
You lowered the dose at AMPS 6/14 but raised it again for PMPS.

See that 70 your got for AM +6 on 6/13? We think she's been doing that a lot, but you simply have not caught it with a test. Most cats drop lower overnight. How low did she go overnight on 6/6 to give you that low of 66 on 6/7 AMPS?

Doses are change too frequently and too soon. You need to hold it for a minimum of 6 cycles or until she hits under 50 (90 if following SLGS protocol).

Right now, I could not tell you when Midnight's nadir is. Too little data. The nadir is what dosing changes are based on for Lantus. You want to know if 0.5U, 0.75U or 1U is right for Midnight? I have no idea. It's a crap shoot.

You need to either get more mid-cycle tests to find that nadir or switch to another insulin like PZI or Prozinc. I think these would work better with your work schedule and the amount of testing you are able to do. They are in and out insulins. No overlap. No depot. Dosing based more on pre-shot values but you do need to get some mid-cycle tests to see how far she drops and develop a sliding scale. Lower chance of remission. No protocol to follow, You have to find what works with your cat.

Becoming more comfortable with shooting those low numbers means you need more testing to be data ready. You can't do that because of your work schedule. It's a vicious circle, with Midnight stuck in the middle.

This is a real rollercoaster ride for Midnight and it's not making her feel very good.

Please, PM Marje and Gracie or Sienne and Gabby. Have them come look at your spreadsheet. You need more feedback.

 

[TMR]

I feel so bad! Now I feel like I am screwing up the whole thing instead of taking care of my cat! You said to PM someone, but I don't know what their full names are or how to do that, exactly. Can you help me with that? There has only been one day lately when I have been home and awake to get a midcycle reading during the day. I am on a lot of meds right now to help me sleep because I can't sleep at all on my own, so I am not going to jeopardize my health to get up in the middle of the night on my nights off to test her. It seems like either 0.5 unit, 0.75 unit. or 1 unit will be the right dose. I just have to figure out how to figure it out (if I stay with the lantus). I am going to the vet in a few days to try to do something about the diarrhea, so I will see what he thinks.

 

[Deb & Wink]

It's not that you have screwed up. I screwed up trying to explain what I saw happening on the SS. And explaining why you want to hold the dose and learn to shoot the low numbers.

We know you love your cat Midnight. You've been trying really hard with the data you have to work with.

It seems like either 0.5 unit, 0.75 unit. or 1 unit will be the right dose. I just have to figure out how to figure it out (if I stay with the lantus).

I really think your schedule is a huge factor in what you can and can't do. The not being able to get some tests at times besides pre-shot makes it really hard to know what to do with the dose.

Maybe you can tell me what your schedule is like. Is it every day of the week you work 12 hour days? What are you dong this morning?

I'm a chronic insomniac myself, have been for years. I understand what sleep deprivation can do to you.

I'll PM Marje and Sienne and ask them to take a look at your SS.

You can do a member search in the user control panel and then save them to your friends list.

 

[TMR]

I guess the thing is that I am confused about skipping a dose or giving part of a dose if her blood sugar is below 200 but above 100 or close to 200. So I was thinking that giving 1/2 unit was better than none, to try to avoid high spikes the next time. Here is a typical schedule for me: Monday-get up at 7 am to test/shoot/feed. Sleep 12-3 pm. Test/shoot/feed at 6:15 pm, leave for work at 6:20 pm. Work 7 pm to 7:30 am. Tuesday-return home at about 7:45 am. Test/shoot/feed. Sleep 9am-noon. (THIS IS WHERE I COULD GET A MIDCYCLE TEST, AROUND 1 PM BUT LATELY I HAVE BEEN GONE DUE TO APPOINTMENTS OR OTHER THINGS.) 7pm test/shoot/feed. Sleep 10pm-7am. Wednesday: repeat Monday. HOWEVER sometimes I work 2 nights in a row. In which case I would be testing/shooting/feeding at 7 am Monday, 6:15 pm Monday, 7:45 am Tuesday, 6:15 pm Tuesday, 7:45 am Wednesday, etc. (ALSO, when I say "sleep" during these hours, it might only be 2 of those 3 hours, or at night only 6 or 7 hours. Just trying to paint a picture.)

 

[Deb & Wink]

During the server changeover today, some information was lost. I am reposting what I had saved for this condo.

Deb & Wink said.

Shoot/no shoot threshold of 200 is for people brand new to the board. You have been here for a while. We may be able to lower that shoot/no shoot threshold. When people come over to one of the Insulin Support Group forums, we usually have more test data and can drop the threshold lower, like to 150 on the TR forum.

So I was thinking that giving 1/2 unit was better than none, to try to avoid high spikes the next time.

You are right, giving a reduced dose is better than skipping the dose entirely. But I think there are some opportunities when you could have given the full dose, when you are home for instance. That is what I am looking for. Opportunities. How can we make this work better for Midnight and you. Working around your work schedule. Working around your need to catch up on your sleep. Heck, even I want to take a nap today!

Putting more notes on the SS in the Remarks column would help us to understand why you did the reduced doses. Would you put some more notes there, explaining why you skipped or reduced?

Tuesday-return home at about 7:45 am. Test/shoot/feed. Sleep 9am-noon. (THIS IS WHERE I COULD GET A MIDCYCLE TEST, AROUND 1 PM BUT LATELY I HAVE BEEN GONE DUE TO APPOINTMENTS OR OTHER THINGS.)

Agree. An opportunity to get a mid -cycle test.

Sometimes, even testing to fill in other times on the SS would help. Like on Mondays. Take a test 15 minutes before you head off for that afternoon nap from noon to 3. That would give you another data point around a +4 or +5. Take another test when you wake up, about a +8. Ok, so it probably isn't exact mid-cycle, but it does give us good clues.

7pm test/shoot/feed. Sleep 10pm-7am.

Here is another opportunity to get a test to tell us how Midnight is doing. Take a test right before you go to bed. It may only be a +3, but it will help us.

Getting some of those +2, +3, +4 numbers will help us to know if it would have been ok to give the full dose. We are looking for patterns, not just the mid-cycle tests. That is what I was trying to describe over the course of 6/11 AM to6/14. Look at the SS yourself, try to see that pattern I was describing. I was trying to give you a little bit of a lesson in reading the ss. Make it really small and step back and look at the waves of color. It takes practice to see what the SS is telling you. Just like it took practice to get better at poking Midnight's ear for blood.

We are detectives here. Sometimes, when you don't have enough information, you can't tell what is going on.

Seems to me, you are more of a SLGS (start slow go slow) protocol type of person. I'd like to see that in your signature. Do you remember how to update your signature? User control panel, Profile tab, edit signature and update the text box. Submit to save.

SLGS protocol drops the dose if you get a 90 BG test in the cycle.

I see you were able to get a +6 today. Love to see a before bed test tonight.

Don't know what time zone you are in since your user control panel hasn't been updated with location and you do not have that in your signature. There are various people that are here earlier in the morning. We may be able to help you with that shoot. reduce, no shoot decision. I would have advised you to shoot the full dose this morning. Shoot through the bounce.