Mr Tinkles 6/13

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Laurie and Mr Tinkles

Laurie and Mr Tinkles

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I increased to 2.2u last night, and I also fed Special Kitty for the first time. I was up around nadir, but I didn't test. Tinkles was acting normal at that time. This morning, his +12 BG is 138! :-D So I didn't give him his shot, I fed as normal. I'll check him again in a half hour. If he is still low, it will have to wait for at least 2 hours after that because I won't be home.
 
Michelle, wasn't it you that said you started getting good numbers when you switched to Special Kitty? I know someone said that, and I shop at Walmart so I picked up a few cans to try. Tinkles and Pita both like it, Angel (finicky princess) ate the first can, but turned her nose up at it this morning. :roll:

+13 182
I went ahead and shot 2.2u then.

+2 268
So far so good... hoping for some greens today!
 
Yes. Special Kitty seem to do the trick for us! I hate that you can only get it at Wal-mart. I have to actually drive to 2 different Wal-marts to get what I need, haha They like Mixed Grill, Turkey & Giblets, Chk & Tuna, Super Supper. I have to switch it all around, so they will stay interested in it. ohmygod_smile
 
We got into the greens today....yay! :-D I had to shoot at +11.5 tonight, he was only at 164. But he was up to 281 at +1.5, so I don't think he'll go too low tonite. I'm going to try to catch a +5 or +6 just to be sure.

I know what you mean about Walmart, Michelle. I love the Relion meter, but I hate that I can only get the test strips there. They don't always keep the shelves stocked, and once I had to go to the pharmacy counter to get strips. Thank goodness they had them, the next nearest Walmart is an hour away! I got the SK super supper, mixed grill and chicken & tuna to try. Tinkles seemed to be getting a little bored with the FF, so I figured I would try the SK to mix it up a little. He seems to like them all.
 
Hey! Great numbers today. I want to mention this, but I know some people think differently about using this system. I know you will do what feels right for you, but again wanted to make sure you were aware of it, ok :smile:

Looking at your curve today. Nadir hit past 8 hours. If it were me, I'd decrease the insulin dose. I figured your mid-point and it is 179.5 I know you gave 2.20 units tonight, but I would just keep in mind that you may want to decrease in the morning.

Interpreting the Glucose Curve*

To determine the dosing interval or the type of insulin given, evaluate the peak time.

If the peak time is:

< 5 hours: change to t.i.d. (3/day) administration or administer a longer-acting Insulin.
5-8 hours: continue b.i.d. (2/day) administration.
> 8 hours: change to s.i.d. (1/day) administration.

To determine the dose of insulin or if dysregulation is a problem, evaluate the nadir and range midpoint.

If the nadir is < 100 mg/dl, decrease the insulin dose.

The ideal range midpoint is 200 mg/dI, and 150-250 mg/dl is acceptable. If the range midpoint is:

1. < 150 mg/dl: reduce the dose of Insulin.**
2. 150-250 mg/dl: don't change the dose.
3. > 250 mg/dI: several possibilities exist:
*
The cat may have been stressed when the blood glucose curve was performed.
*
The Insulin dose may be too low.
*
There may be an insulin problem (inactive insulin, insulin not mixed property, poor injection technique, poor absorption).
*
Insulin resistance may be occurring due to concurrent disease (systemic Illness, hyperthyroidism, hyperadrenocorticism, acromegaly) or insulin antibodies.
Click to expand...

Here's the link for above information: http://www.felinediabetes.com/bg-curves.htm
 
Thanks for the info! I read it, and it says if the midpoint is between 150-250, keep the dose the same? I know his nadir was late, around +9, but he also didn't get a snack around +6 as he usually does, so that may have had an effect too. He was rising pretty fast at PM shot time. At +3.5, he is at 236.

I did go a little skinny on the 2.2u tonight, he was low and I wasn't sure how much he would rise from the meal. I'll see where he is when I test around +6...if he's low, I'll give him a snack and test again as needed. Thanks for the input, I really do appreciate it!
 
I just wanted you to know that that info was out there. :-D You're doing awesome and mama knows best, so go with your feelings. It does say:
If the nadir is below< 100 mg/dl, decrease the insulin dose.
Click to expand...
but that's when you have to consider all the other stuff too, such as the mid-point. Sending more good numbers your way! I'll check on you tomorrow. Give Mr. Tinkles a hug for me.
 
That's interesting, I hadn't read all that since when I first got here. The range mid-point stuff looks a little old-school to me, since they are recommending a mid-point higher than my no-shoot, lol! It's an interesting way to look at it though.

For me, I would reduce the dose a hair based on getting the 138 PS. You (anyone) are looking for the dose that gives you a shootable PS at +12, ideally IMO in the 150 - 180 range, and an ideal nadir in the 50 - 80 range (or 80-100, depending on how your meter runs). So if you aren't hitting those #s, either going too low or too high, IMO that's an indicator for a dose change. Unless your schedule is really flexible, if you get something below 150 at +12, it's generally going to be a pain then to retest, etc., so to me that's where you want to reduce the dose a teeny bit aiming for a shootable # at +12. Of course if the nadirs aren't cooperating you may have to throw that thinking out the window, but that's where I'd start. Really just the same advice I think, but looking at it from a slightly different angle.

You also got an excellent nadir off a +13 shot, which suggests to me if that dose worked that well at +13, it may be a hair strong for +12. 2u wasn't doing it though, so I'd probably try just shaving a teensy tiny bit off that 2.2u. Watch too for rapidly improving #s. It might not happen, but sometimes when their livers have been in training, staying in good #s for several hours can help their liver settle down, and then the zoom will settle down and they won't need as much insulin to keep the good #s. I'm not sure how much that has been a factor in his case, but just something to be aware of, the "dose reduction path" may or may not be on the horizon. If so, you just roll with it as best you can, and lower the dose a tiny bit anytime the PSs start getting below 150 or the nadirs below your comfort level (50-80 depending on your meter & POV).

In any case though these are awesome #s, yippee!!! :RAHCAT It's so nice to see how pretty things go when the insulin is working well for them!
 
+7 137
+9 128
+10 130

I had read that info before, but I had forgotten about the midpoint info. I agree that it is a little old school but worth considering. The nadir is around +9 again, but he never got into non-diabetic range.

I'll see where he is at +12. I'm inclined to stick to the dose and see if he settles into it, but of course I am listening to the advice given and considering it! I can be flexible for the next few days, so I can wait to shoot until +13 or later if need be. I really want to see him in the greens! I'll be watching closely.

Thank you so much for the advice, I do appreciate it immensely! It really helps to get experienced input!
 
That's great that you can be flexible for the next few day. I also wanted to point out about what is mentioned as far as the nadir being greater than 8 hours (which it was yesterday) it said insulin should be given once a day, but again.. gotta just take everything in and go with what feels right.

Looks like Tinkles is riding in the upper 120's, so he may not raise until +14ish. Unless, he's still going lower which I would just wait til he raises and lower his dose. I hope you were able to get some sleep! I feel for you! :YMHUG:
 
Sometimes with Bix I have found that late nadir is sort-of his protection plan it seems like. If I lower the dose a hair then I see better #s earlier in the cycle. Doesn't always work that way though. I think what you are doing is fine, it's just a matter of possible fine-tuning and experimenting. Regardless though the #s are great, so keep up the good work and enjoy the blue #s!!!! :mrgreen:
 
I've been studying T's SS trying to figure out a pattern. @-) One thing that's got my mind confused... is the mid day feeding. I hope someone else can chime in about this, but my only experience with giving more food is when Pru was at 0.2 units cause I knew her numbers at that point. Not sure if that made sense. ohmygod_smile

IMO - I think sticking to feeding 2x day until you know how the insulin is working. Maybe if you're feeding 2oz AM and 2oz PM - try to give 1oz AM, 1oz mid-day etc. I'm just not sure how much you're feeding? and if it's messing with true numbers? I am also thinking SID or 1.10 AM & 1.0 units PM... just my thoughts. I'm going to go back and look at SS :smile:
 
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