Murphy needs dosing advice tonight

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Carol & Murphy (GA)

Carol & Murphy (GA)

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@Rachel @Robin&BB @Merlin OR ANYONE
please look at Murphy's spreadsheet today - his glucose levels continued to fall throughout the day - I took the pmps reading at +12.20 and it was 181 - I stalled about 15 minutes and it was 179
I let him eat some as he was miserable waiting
soo -- should I give him a skinny 1 in a bit - or 0.5 units? any thoughts appreciated should I wait to take another reading even after he ate
I only got 4 hours of sleep last night, and I absolutely cannot do that again tonight
 
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Hi Carol, I wish I knew what to tell you. I was reading the ProZinc protocol and it said: If one preshot is above 200 and shootable, and one preshot is too low to shoot, it probably means the dose is a little too high and lasting more than the usual 12 hours. Try reducing by at least .25 to see if you get two shootable preshot numbers (ideal) rather than one that is too high and one that is too low to shoot (not ideal). I wonder if your AM shot should be reduced? That doesn't help you tonight though, sorry. I hope someone comes on soon that can advise.
 
Sharon14 said:
Hi Carol, I wish I knew what to tell you. I was reading the ProZinc protocol and it said: If one preshot is above 200 and shootable, and one preshot is too low to shoot, it probably means the dose is a little too high and lasting more than the usual 12 hours. Try reducing by at least .25 to see if you get two shootable preshot numbers (ideal) rather than one that is too high and one that is too low to shoot (not ideal). I wonder if your AM shot should be reduced? That doesn't help you tonight though, sorry. I hope someone comes on soon that can advise.
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thanks Sharon - the problem is that his amps was about 550 today - but thanks I think I will reduce the am dose to 2.5
 
I'm sure Robin, Sue or Rachel will be on at some point to advise on the AM dose. I think you did fine with the 1u.
 
Carol C said:
thanks Sharon - the problem is that his amps was about 550 today - but thanks I think I will reduce the am dose to 2.5
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Sorry, Carol - Ony just now saw you'd tagged me. Yes, I think you're okay that ou have him that 1 unit.

About that 550 AMPS: Although I know seeing that kind of a number is kinda scary, I'd suggest not raising the dose with a bounce like that; that 3.0U may be the reason you saw the number you did at PMPS. I know it feels counter-intuitive, but is better when that sort of thing happens to either hold the previous dose (which was 2.0) or reduce the dose slightly. In reviewing Murphy's SS over the past week or so, I'm thinking it's possible that two things could be in play here:

1) He may be one of those kitties whose body reacts more intensely to dose changes in excess of 0.25-0.5U, and/or ...
2) He may need his doses held for longer than just 2 to 3 12-hr. cycles, as some kitties take a little longer to settle into a particular dose.

So ... Murphy got 1 unit tonight, is that correct? Can you manage a test around +4 to +5 just to see what he's doing mid-cycle?

Depending on the preshot# you get in the morning, you may end up only giving him just 1.5U-1.75U - at the most, go back to that 2.0 U. (I've just got this feeling that maybe 3 units is a little too much for him?) Might try holding Murphy's AMPS dose (especially if you end up going for 2.0) a little longer than you've been doing - for more like 4 to 6 cycles (2 to 3 days). Then, when you do make a dose adjustment, might try making that in a smaller increment; 0.25 to 0.5 units max.

This is just an idea, mind you - but if this were my kitty, that's what I'd consider trying next.:)
 
Robin&BB said:
Sorry, Carol - Ony just now saw you'd tagged me. Yes, I think you're okay that ou have him that 1 unit.

About that 550 AMPS: Although I know seeing that kind of a number is kinda scary, I'd suggest not raising the dose with a bounce like that; that 3.0U may be the reason you saw the number you did at PMPS. I know it feels counter-intuitive, but is better when that sort of thing happens to either hold the previous dose (which was 2.0) or reduce the dose slightly. In reviewing Murphy's SS over the past week or so, I'm thinking it's possible that two things could be in play here:

1) He may be one of those kitties whose body reacts more intensely to dose changes in excess of 0.25-0.5U, and/or ...
2) He may need his doses held for longer than just 2 to 3 12-hr. cycles, as some kitties take a little longer to settle into a particular dose.

So ... Murphy got 1 unit tonight, is that correct? Can you manage a test around +4 to +5 just to see what he's doing mid-cycle?

Depending on the preshot# you get in the morning, you may end up only giving him just 1.5U-1.75U - at the most, go back to that 2.0 U. (I've just got this feeling that maybe 3 units is a little too much for him?) Might try holding Murphy's AMPS dose (especially if you end up going for 2.0) a little longer than you've been doing - for more like 4 to 6 cycles (2 to 3 days). Then, when you do make a dose adjustment, might try making that in a smaller increment; 0.25 to 0.5 units max.

This is just an idea, mind you - but if this were my kitty, that's what I'd consider trying next.:)
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I'm up for something like that - when you say depending on his amps - can you be more specific - under what circumstances would you not go with 2 (or what about 2.5)?
 
Carol, I am so so sorry! It's been a nutty day around here, and I totally forgot to check in.

I think the skinny 1 was fine. I would like to stress that it's important to get some tests in tonight since he was dropping...just to be sure all is well.

I agree with Robin. Let him have a lower dose in the morning...something between 1.5 or 2 even if the number is high. While it may seem wrong, that dose you gave this morning seems to have lasted all day...way too long. A lower dose might do better. And what I would do is choose a dose, and as long as his preshot is over 200, STICK with it for 2 to 3 days like Robin said. If you stick with it for a few days, and get some midcycle tests in (which you already do a fabulous job of!) it might tell us if he just needs a few days to settle in to a dose. Some kitties are just like that. Anyway, that's what I would do. If it doesn't work, we can always adjust the dose, but we have to experiment some...so choosing a lower dose and trying for a few days could at least tell us if that is something we don't need to do !

Also, could you get a ketone test in sometime soon? Just to be sure since he's had some higher numbers. :)
 
Carol C said:
when you say depending on his amps - can you be more specific - under what circumstances would you not go with 2 (or what about 2.5)?
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You may see a high AMPS, you may not. If it's really high, go back to the 2.0; if it's only around 200-250, I'd be more inclined to "inch" him back toward the 2.0; hence the suggestion re: a 1.5-1.75. My reasoning is this: He only got 1.0 tonight; he seems to not do so well on dose changes of more than a half unit ... does that make any sense? (Gentler increases may help him in the long run.)
 
Yes to all - I do understand the rationale - I have been trying to get a ketone - it's more difficult now that his peeing is almost back to pre-diabetic levels (yesterday he only peed twice) I'll make a special point tomorrow - but I guess going back to the point of not making drastic changes - what about decreasing to 2.5 rather than the drastic 2?
 
Carol C said:
I guess going back to the point of not making drastic changes - what about decreasing to 2.5 rather than the drastic 2?
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Let's take a closer look at the last couple of days:
10/10 (yesterday) - AMPS Murphy's dose was 3U; that was reduced to a skinny 2.0U @ PMPS (slightly more than 1 unit reduction).
10/11 (today) - High AMPS, his dose was increased to 3U (slightly more than a 1 unit increase); tonight he wouldn't hit 200 for you @ PMPS, so he got a reduced dose later than usual @ 1.0U (a two unit decrease).

Although you may see a high AMPS tomorrow, I think it's important to not overreact to the number at this point - as it appears that these significant dose increases are causing some problems (and may also be that dose changes are happening too often for his body to handle).

I think that an increase in the morning of 1.5U (which is what going with 2.5 would be; i.e., another significant change) would just give you more of the same pattern you've been seeing. This is why I'd proposed a gentler return to that 2.0.

If he's really high, go ahead with the 2.0, and monitor mid-cycle like you've been doing. But then try holding that dose for 4 to 6 cycles and let's see if that helps solve this puzzle. And then, if the need for a dose increase becomes clear, do it in the smaller increments of either 0.25U or 0.5U max.

Do you see what I mean? I know it's really, really hard to be patient, Carol; I can so relate to that.;) But this is a process ... and Murphy's only been on ProZinc since early August, right? :bighug:
 
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P.S. If it's any consolation, Bet-Bat's still driving me, well ... batty!!!:D (Can't even tell you how many pairs of patience pants I've worn out.:rolleyes:)
 
Robin&BB said:
P.S. If it's any consolation, Bet-Bat's still driving me, well ... batty!!!:D (Can't even tell you how many pairs of patience pants I've worn out.:rolleyes:)
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Yes, He started insulin August 6 I think yes, that makes sense -but I did do all those doses (1, 1.5, 2, 2.5, and his numbers were always very high- but I agree this is a good plan of action as he can't remain in this pattern Thank you so much
 
Carol C said:
Yes, He started insulin August 6 I think yes, that makes sense -but I did do all those doses (1, 1.5, 2, 2.5, and his numbers were always very high- but I agree this is a good plan of action as he can't remain in this pattern Thank you so much
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You're welcome, Carol!:) (And as @Rachel said earlier, please try to get a test in around nadir time tonight, ok? May need to adjust that some, based on what time you'd ended up dosing him.)
 
Carol C said:
Yes, He started insulin August 6 I think yes, that makes sense -but I did do all those doses (1, 1.5, 2, 2.5, and his numbers were always very high- but I agree this is a good plan of action as he can't remain in this pattern Thank you so much
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It's like it's a moving target, Carol. At first he was adjusting to the insulin and the food, he was running higher overall so 1.5 in August may have had a very different effect than 1.5 today, when his body is using the food and insulin more efficiently. This is a good thing - that he needs less insulin as time goes on. But yes, it makes your job more, ahh, interesting. :confused:

When you need a good night's sleep, I'd suggest lowering the dose a smidge and go to bed. He is not dropping to dangerous lows. He'd be fine.
 
I'll be interested to see your mid cycle numbers today. I know that black looked discouraging but look at the actual number...it's lower than yesterday. And only 100 points higher than your +3 lat night...
 
Rachel said:
I know that black looked discouraging but look at the actual number...it's lower than yesterday. And only 100 points higher than your +3 lat night...
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Now that I've had some :coffee::coffee::coffee: & am finally awake ... @Rachel has a very good point here! It can take some time for a bouncy situation to settle down, so try not to be too discouraged by that high AMPS today (which is 41 pts. down from yesterday's AMPS, btw). I can imagine how tempting it was to shoot @ 2.5U, so just want to say: GOOD JOB, shooting that 2 units! Let's see what happens over the next 2 to 3 days ... as trying something new (look out, bad pun coming) is always "worth a shot.":rolleyes: <insert groans here> Hang in there, Carol!:bighug:
 
Carol C said:
okay we've been in the pinks all day actually - kind of a flat day I was a little surprised the pmps wasn't higher
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After that AMPS yesterday, that he stayed in the pinks is okay (that's a plenty big enough drop for now); was glad to see he didn't spike you another number in the 500s tonight! Maybe he's just "easing" his way out of that bouncy thing ...
So let's see how Murphy's daytime cycle rolls out tomorrow at this dose.

Can you get in a mid-cycle test or two tonight?
 
I'll get in a test tonight -I was surprised he stayed so flat - and a little concerned - of course, I'm second guessing myself that I should have done the 1.5 this morning - but with the amps, I just couldn't yes let's see what happens tomorrow thanks again, Robin I am so appreciative
 
Carol C said:
I'll get in a test tonight -I was surprised he stayed so flat - and a little concerned - of course, I'm second guessing myself that I should have done the 1.5 this morning - but with the amps, I just couldn't yes let's see what happens tomorrow thanks again, Robin I am so appreciative
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And now that you've mentioned it, I'll say it now because I'll probably be dead asleep;) at your AMPS time:

If by chance Murphy gives you a number less than 200 @ AMPS*, that's your cue that 2.0 was a little too much. If that happens, stall without feeding & recheck his BG in 15-20 minutes to see if it rises in anticipation of food. Then, if it does rise, reduce to either 1.75U or 1.5U.

If he hits at least 200 right off the bat at AMPS, you can just hold the dose @ the 2.0. But ... if he stays high & flat again through the day cycle, that's yet another kind of clue that the dose is probably a little too high - and at that point you'd drop it to either 1.75U or 1.5U at PMPS. (I'm thinking his body might respond better to these smaller reductions.)

*ETA: I'm not anticipating that this would happen, but you never really know with our crazy little sugar kitties ...o_O
 
Carol C said:
okay with scenario #1 - amps<200 and a stall doesn't work - what would I dose? 0.5 or 1 unit?
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What I always did with Bat-Bat was: Kept up the stalling for more rounds of tests (after the 1st AMPS test), withholding food and allowing 15 minutes between the tests. That gives you up to 1 hour of stalling to get the BG to rise on its own to 200. If you can't get there, you skip the dose. (Could you dose at 198? Well yeah, I suppose - IF you can monitor. In general is better to skip, because at that point, you've already given it a good hour to rise.
I know it's tempting to try doing what you did last night, but look at what happened when you shot a skinny 1U. Didn't you shoot that after stalling and geting a 179?

It's really not the end of the world to skip a shot if you can't get to that safe-to-shoot #. I personally think that sometimes it's better just to skip and deal with a higher # at the next preshot than trying to jigger the dose after a long bout of stalling, because the need for that stall is telling you he's hanging onto that dose longer than 12 hours - see? And then after that little "breather", you give the reduced dose next pre-shot time*.

Someone else may have a different opinion ... but my vote would be - after an hour of stalling - if you can't get to 200, you just skip the dose, period. Someone else may have another opinion; and that's fine, too. In the end, Carol, it's your decision - as it's your kitty, and you who holds the syringe.;)

*ETA: Meaning either 1.75U or 1.5U.
 
@Robin&BB your take on this is very interesting - I got my idea of giving a small dose by reading a thread in the think tank forum discussing the hazards of skipping (DKA) and it may be better to give a token dose. I really don't know- but I hope I don't have to deal with this issue in the near future It's complicated
as always, very appreciative of your advice
 
Carol C said:
@Robin&BB your take on this is very interesting - I got my idea of giving a small dose by reading a thread in the think tank forum discussing the hazards of skipping (DKA) and it may be better to give a token dose. I really don't know- but I hope I don't have to deal with this issue in the near future It's complicated
as always, very appreciative of your advice
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Yes, it can be very complicated: And if Murphy's had any episodes of DKA (or if you feel he's at risk for that), that puts a completely different spin on the whole situation. (I don't really have any personal experience with DKA, so am happy to defer to anyone else here who has better knowledge about that as relates to giving a minimal dose rather than doing a skip.)
 
That PMPS was actually pretty nice..considering his AMPS. Remember, this is just an experiment...a few days of trying something different. If it doesn't work, we try something else! ECID!

Has Murphy ever had DKA?
 
Gotcha! I wouldn't worry too much. I believe DKA generally shows up with high numbers, not eating, and infection. Not to say it can't show up otherwise...but I know you get ketone tests in so I wouldn't be concerned. It's when they aren't eating that we worry...because you don't want to give insulin if there is no food on board to help, but you don't want to NOT give insulin since they aren't eating and their numbers might be higher due to no insulin...etc. I remember when Gypsy wouldn't eat (she had other medical problems I didn't know about) it was a concern. Skipping due to low numbers is fine usually since you don't want a hypo risk!
 
I'd go with 2, yes. If he is high tonight, we can reconsider. But I think 2 for the day to see where it takes him would be good. :)
 
Hey Carol - if you are on that new schedule (12.5/11.5), you might want to draw a colored line across your spreadsheet to note that since it is an experiment. That way, you can easily identify that you are trying something new. I do that for a change in food, a new bottle, or something that I want to monitor to see if I see any different patterns. Yeah a pink this AM...so much better than a red or black.
 
Carol C said:
interesting his amps almost identical to yesterday's pmps
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Good morning, Carol!:)Was glad to see that you got two preshots in a row that were in the pinks - this is much better than a 554 AMPS followed by a 181 PMPS.

Was reading through the comments section of your SS; re: the sniffles - does Murphy have a cold right now?

Also, you'd written earlier that he eats 4x/day (which is fine; I can see you've sometimes had trouble getting him to eat for you). But what are the other two times of day he eats (as relates to the SS - ex: +4 or +8 ... or what?). I ask only because knowing the timing of all of Murphy's meals helps us better understand his patterns/numbers throughout the 12-hr. cycles ... (For instance: Did he get any additional food between PMPS & +5 last night?)
 
@Robin&BB - He was seen by my vet - he has bad seasonal allergies and ragweed terrible here now so lots of sniffles Last week I was ready to put him on antibiotics but I switched his antihistamine from zyrtec (which seemed to stop working) to chlorpheniramine - he is better now and don't see evidence of sinus infection (just stuffed up especially in the mornings) I am keeping a close eye on it now. His eating is a moving target - He is on dry and develops food aversions so easily. Right now after each of his pre shot readings, I give him 1/8 cup of Royal Canin glycobalance followed by about 1 tablespoon of Royal Canin canned novel protein venison - I'm slowly trying to see how much of this he will be able to tolerate - my hope is to build it up to 1/4 can a day - that usually takes us up the first 1 hr-1.5 hr after the shot. About 2.5 hours after his shot, I have been putting down a tablespoon of Young Again mature 0 carb which he nibbles on until I take it away about 4 hours before his pmps - he is a grazer and only eats a little at a time. At night I just leave the Young Again out all night - usually he eats it all sometime during the night - last night he didn't though. I can't really predict how much he will eat or how long it will take him to eat it
 
Robin&BB said:
And now that you've mentioned it, I'll say it now because I'll probably be dead asleep;) at your AMPS time:

If by chance Murphy gives you a number less than 200 @ AMPS*, that's your cue that 2.0 was a little too much. If that happens, stall without feeding & recheck his BG in 15-20 minutes to see if it rises in anticipation of food. Then, if it does rise, reduce to either 1.75U or 1.5U.

If he hits at least 200 right off the bat at AMPS, you can just hold the dose @ the 2.0. But ... if he stays high & flat again through the day cycle, that's yet another kind of clue that the dose is probably a little too high - and at that point you'd drop it to either 1.75U or 1.5U at PMPS. (I'm thinking his body might respond better to these smaller reductions.)

*ETA: I'm not anticipating that this would happen, but you never really know with our crazy little sugar kitties ...o_O
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@Robin&BB @Rachel It looks like Murphy had a flat day again today and hanging onto the insulin at least at +10 - we'll see in two hours what the pmps is but I doubt it will be very high - if that is the case, should I plan on a skinny 2 (note I have the u40 syringes and a skinny is the best I can do in lieu of a 1.75 - or should I stick with the straight 2?
 
Well ... is looking like maybe the dose is still a little too high, perhaps. Are your U40 syringes marked on the half unit, or only on full units?
 
Somebody recently mentioned having U40s marked on the half-unit. (I wonder where you get those? Mine were like yours are; that's why I switched to U100s marked on the half-unit & started using the conversion table...) Yeah, I'm really starting to think that he needs to be down at 1.5, given the high-flat thing he's stuck in. Let's see what he's going to do at PMPS; sounds like you may be in for a little stalling, though.:rolleyes: (Is he acting like he's hungry, I hope?)
 
I am confused now - I thought that stalling was only when the BG was <200 - I'm sure this will be around 300- and yes, he is already in front of the refrigerator waiting for his food in over an hour
 
Duh - Sorry!:oops: I thought you meant he was going low on you. So disregard the comment about stalling.:p
 
Robin&BB said:
Somebody recently mentioned having U40s marked on the half-unit. (I wonder where you get those? Mine were like yours are; that's why I switched to U100s marked on the half-unit & started using the conversion table...) Yeah, I'm really starting to think that he needs to be down at 1.5, given the high-flat thing he's stuck in. Let's see what he's going to do at PMPS; sounds like you may be in for a little stalling, though.:rolleyes: (Is he acting like he's hungry, I hope?)
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I got some u40's with half markings from ADW
 
So let's say the pmps will be around 300 - should I do a skinny 2 (guessing it would be ~ 1.75) or should I get a ruler and measure out 1.5 ? Or should I just wait to get the Pmps and we can decide then? Thanks @Sharon14 - do you need a prescription for the syringes from ADW?
 
I'm still thinking 1.5, but if you'd rather kind of ease Murphy in that direction with a 1.75 tonight, I think that would be ok ... but it's up to you. What's your own 'gut' saying to you?
 
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