Mr Tinkles 6/4 dose advice needed

Hi again! I lowered Tinkles dose to 1.5u for several days, then raised it to 1.75u for the last few days. It looks like we are making some progress, which is great, but I got a little off schedule now. I had to shoot at +13.5 last night, and he is at 240 @ +11 this morning. I opted to wait and feed him later than normal, so I will test and feed at about +12.5. If he is still much lower than he has been at PS times (450ish) then should I lower the dose, and how much? His SS is updated, and I would really appreciate some input!

 

Good morning!

I don't see the spreadsheet link in your signature. Hmm, I don't see your signature at all. Under options there's a box to check "attach a signature". Is yours checked?

 

Wow, that is really strange. It shows my signature with the SS and profile when I go to the user control info, but it isn't linked to my post...

Hmm...it's linked to this post though....odd!

Ok, I went back and edited the original post, now the signature is attached.

+13 is 278.

 

hi laurie, pzi is pretty forgiving about exact timing. so even tho' i can't see your spread sheet i would go ahead and shoot an hour early an hour late on occasion does not matter. then you can get right back on your schedule again. do shoot according to the #'s you see at that hour if you are considering a dose change.

 

Thanks Lori! His +13 is 278, so I'm thinking that I need to shoot 0.75u, slightly less than half his usual. Does that seem reasonable, or would 0.5u be better?

His SS should be visible now.

 

I so don't like giving dosing advise ... here's what I see though, 1) Mr. Tinkles bg is clearly on the rise (unless breakfast has just hit his system), 2) shot is late, so there will be less insulin overlap, 3) yesterday mornings nadir was almost 200, which leaves you with a full 100 point extra drop comfort zone.

Last night's nadir may have been lower, and the duration of the shot looks good.

Seems like you have made some progress! Good work.

I would be tempted to go with the full dose if I was around all day to keep an eye on the kitty and test around nadir time. Otherwise, my comfort zone would be to reduce a bit (.25 to .5u). Sliding scales work for some, but not for others. Not sure how you figure out which group you are in. Shooting a little too much, can result in rebound, which takes a couple of cycles of higher bg before it clears out, and delays the whole getting regulated process.

 

Laurie honestly your changing your doses too dramatically to see what they are doing. start low go slow works for me...pick your small dose and stay with it for a time barring anything like a very low #...under 150 but this constant dramatic dose change won't inform us of ANYTHING. go with 1u for awhile. IMHO and stick with it. that's how you learn.

 

I wanted to add to my comment about with my kitty in a similar situation, sticking with the dose, rather than reducing, because 1) Buddha will often zoom from a reasonable bg to a very high bg and 2) I test at +2 or so to see if that zoom happened and if it didn't then I feed snacks and test every hour or so until past nadir. Buddha is a great eater, so I don't have to worry about him not scarfing extra food. If he was the finicky sort, I might be more timid in shooting.

 

Thanks for the input!

Donna, thanks for explaining your thinking, it helps a lot! I'm really hesitant to go with the full dose, because I don't want to undo the progress I've made to this point. The last time I shot the full dose on a low number, we ended up in a rebound, so I think he's sensitive to fast drops. I ended up giving 1.25u, after he ate a larger than normal breakfast. I will be home for the next 9 hours or so, and will run a curve to see what happens.

Lori, I know you are seeing the previous dose swings, but are you looking at the last 10 days? I lowered his dose to 1.5u for a full 5 days, and it looked to me like that dose was insufficient. I then raised it to 1.75u, and it took a few days for him to settle into that dose, but it seems to be pretty close to a good dose. From what I've been reading here, it seems common practice is 2-3 days before assessing and changing dose, so I think I've waited long enough between adjustments, but please correct me if I'm wrong! I don't think 1.0u would be sufficient, since 1.5u wasn't enough. Am I missing something?

I understand start low, go slow.... he started on 2.0u BID because his BG was 600, and his vet wanted me to raise him to 3.0u BID after 2 weeks, which I refused to do. (Good thing, he'd be dead!) :shock:

 

well let me go back and look at your SS again.
tom was dx'd at 560 and we started on 1u and that was in 07 and it took about 5 days before we saw any progress but then in 30 days we were OTJ. in those days it was rare to see cats go up to the 400's and I think that a result of too much insulin from the start.

 

ok took a second look...i still think i see alot of bounces becuase your kitty is accustomed to high #'s so when he hit's the greens his body's tendency is to go back to 'normal' and if you push thru that with the same dose for a while you will know better what's going on.
The 2 or 3 day dose adjusting comes after you've been doing this awhile and KNOW your cat and what is going on. at first it takes awhile to settle. that's why experienced users can shoot at 130 but not you, no no. You need to have patience and not let those bounces scare you into more bounces. let him ride for awhile. how's tinkle's feeling and looking?

 

I think you are right that his body is used to the higher #s and his body panics when he gets into the greens, so that was my thinking when I dropped him to 1.5u....gradually raise the dose and allow him to acclimate to it. He wasn't doing as well on 1.5u, more peeing and drinking, less preening, lost 1/2lb...it was obviously not enough, even without the BG data...which also showed lack of regulation. He is much better on 1.75u, gained back the 1/2lb, more normal behavior...still peeing and drinking more than normal. However, if I had given 1.75u this morning, I'm certain it would have sent him into rebound, so I don't think letting it ride would have been the right course. As it is, his # after eating a larger than normal breakfast was only 381...much lower than his normal PS # before eating. +1 is 365....that is 2 hours after breakfast.

 

Here's the latest #s. SS is updated.

+2 335
+3 331
+4 310
+6 289
+8 211

Not too bad, interesting that the nadir seems to be later...it is usually at +6, but it seems like others are also seeing the nadir moving after being on ProZinc for a while. Today is day 38 on ProZinc for Tinkles.

 

will be interesting to see pmps..

 

+9 258
+10.5 301

Looking good so far, no big zoom yet. I'm going to shoot at +11.25, trying to ease back to regular schedule. I'm most likely going to go back to the 1.75u dose, as long as he eats normally, and will set my alarm for a +6 test.

ETA: +11 276 ....suspect that the 301 was a little elevated from stress, had to poke more than once, he was annoyed with my incompetence! lol He hoovered up his food, I did give the 1.75u and will give him more food in an hour or so, he seems especially hungry today. He normally eats 9-12 oz FF per day, today he ate 12oz and is looking for more!

 

that's strange, my tom was extra hungry today too.
i like that he was coming down on his own, always a really good sign and one to pay close attn. to. next time wait and test again in an hour and see if the self come down continues.
that is your indication tinkles may want to be packing for the falls.
you said you'll test tonight right? that's good, especially with that self CD

 

Yes, I'll be checking him a few times (at least) overnight. The point about the self CD is something to consider, and keep in mind for the next time. I really didn't want to wait any longer to shoot, I need to get back on schedule, and I really think the 301 was a false high.

I got thinking and looked back over my notes, he has been plagued with a URI and I had him on Amox and eye ointment, along with duralactin paste. I ran out of duralactin on 5/28 and discontinued the antibiotics on 5/31, because the infection seemed to be gone....but he was still sneezing/watery eye so I bought some l-lysine and started putting it on his food on 6/1. It seems to make a big difference with the symptoms, and perhaps it has something to do with his lower BG readings?

He is an eating machine today, I forgot he had a snack earlier today, and he just ate another 2oz...so up to a grand total of 15.5oz! I am SO thankful that he eats well, he never turns his nose up at anything I give him....I'm very lucky.

 

Overnight #s:

+2 324
+4 200
+6 220
+8 272

Not sure what to make of that...

 

Good Morning L and Mr. T

You wrote that you are incompetent at testing.

Have you tried using a rice sock?

Before I did, poor Duke was like a Voodoo doll. I thought Duke was one of those poor bleeders I read about. It turned out I was really a poor tester.
Since using one it takes only a few minutes to prep and test.
The sweet spot is actually the sweet spot. Pretty much one small stick.

Sorry if I already suggested this. I feel like the newly converted rice sock preacher, but it works so well for us.

BD

 

Good afternoon BD!

I have tried the rice sock, but rubbing the ears works better for me. I'm not having a problem getting Tinkles to bleed, just getting him to hold still at times! He doesn't like to wait the 5 seconds it takes for me to test him, so he pulls away. He is just impatient, he wants his treat NOW!

Thank you for the suggestion, though! All thoughts and suggestions are appreciated!