Napa: AM shooting dilemma, day 2

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ebuckley

ebuckley

Member Since 2014
Hi all, hope all the furry ones and their beans are doing ok tonight.

Looks like Napa's been under 100 a good chunk of today on Lantus ~0.5 bid x 4 days (down from 1.0). AMPS 158, +8 80, +10 61, PMPS 91 Also, switched to the Relion meter this afternoon.

I still have limited data, but she seems to hit Nadir late, especially approaching PMPS (but not so much approaching AMPS for some reason--lack of food over night not stimulating the pancreas?? bounce??).

Last night with 96 at PMPS, I waffled, then gave her a reduced dose and checked on her a couple of times over night with one meter check. She seemed fine; BG 125 +5 post PM shot.

Re-read the Lantus protocol guidelines today--they make more sense to me now that I am not as overwhelmed. It sounds like I need to get to a point where we keep going to keep her green (shoot low to stay low). But not really sure if we are there yet. I don't want to set her back or dry up the depot, but I certainly don't want to tank her either, esp. when I am not around to monitor.

The P's are pretty good. Poop good; Pee definitely better, but maybe still a wee bit heavy; Play/Preening not too much but definitely alert and active, and she is jumping and walking better the last several days; Purring...well she comes up to sit in my lap but swishes her tail wondering if I'll poke her with something.

I'm trying to make best use of the info already here, but, of course, any advice is welcomed: Proceed cautiously with 0.25 (as best as I can even pull that off) or .5? Many thanks if you can; in any case I'll post an update tomorrow.
 
Re: Napa: Green is good, but not sure about full dose tonigh

ebuckley said:
I still have limited data, but she seems to hit Nadir late, especially approaching PMPS (but not so much approaching AMPS for some reason--lack of food over night not stimulating the pancreas?? bounce??).
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This is often a sign the dose is too high. Remember: you want a dose that is safe to give twice a day so if you find yourself skipping a lot of shots because the numbers are too low, that usually means the dose is too high. I would suggest lowering the dose to .25u for the next few cycles.

As for whether or not to give the shot tonight, that's up to what you feel most comfortable doing. You can stall and test again in a half hour and if it's a "rising" number, you could go ahead and give .25u if you're going to be around to monitor, just in case. Or, you can skip and write it off as a fur shot. Just be aware that the numbers will probably be higher tomorrow as a result.
 
Re: Napa: Green is good, but not sure about full dose tonigh

I agree with Kay. I looked at your ss yesterday and was thinking about it then but I wanted to see how 0.5 played out. But again you got a low green preshot last night so I would Try 0.25 for a few days and see how it goes.
 
Re: Napa: Green is good, but not sure about full dose tonigh

Thanks all. I went with the ~.25, checked on her 3x overnight but no test, gave her one small meal around 3 am. This morning she was very cranky and hungry, swatting at her sister. About 15 mins to get the ear to bleed and she came out 369 :-( with a 395 recheck. Bounce vs test stress vs depot running dry from little doses? Oh well. As others here have said, "its a process."

I started out feeding while testing, then moved away from that lest we needed the option of holding food to stall. But she is much more accommodating of the ear assault if she is face planted in her bowl. Might go back to that at least for the mornings.
 
Re: Napa: Green is good, but not sure about full dose tonigh

It's probably a bounce or possibly a fur shot from last night. Hold the .25u dose for 3 days/6 cycles and let's see if Napa evens out for us. ;-)
 
Re: Napa: Green is g....what the heck? Now red?

Ugh! What a jump :-(

Reds and pinks???? Is this what a bounce looks like? How long do they typically last? I'm pretty sure there haven't been fur shots recently.

Have only made tiny changes to feeding schedule: not feeding until after shots, and cut down the big meals of breakfast,lunch and dinner to ~2oz down from 3 oz in order to serve that extra ounce just a little later and spread out the food a bit more when I can.

Holding onto .5 for now. It was a bit fat this am but definitely under 1. Have a long work day today and can't monitor.

And I have to go out of town this weekend. I think I'll search first then post my dilemmas about that in a separate post.
 
Re: Napa: Green is g....what the heck? Now reds?

Napa could have dropped really low on 2/3 PM. Looks like she started bouncing on 2/4 AM. Bounces can last up to 72 hours, so you need to be patient and let the bounce clear.

Here are some patience pants for you to wear while you are waiting for that bounce to clear.

Hope you like these pretty blue ones.

You might want to think about getting a regular test every evening, after the PM test. Especially if Napa is really low when you shoot, it's a good idea to try to get a +2 to tell us where she's headed.
 

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Re: Napa: Green is g....what the heck? Now reds?

So shocking to see these numbers after things were going so well.

Patience pants on. Feeling reassured. Thanks Deb.
 
Re: Napa: Green-red-blue bounce ...yay!

113 AMPS. Was tempted to stall and try to shoot but decided not too because:
- gun shy now
- tested with a full meal
- not much wiggle room on 12 hour spacing for the next 3 cycles

We are going to have to do a small OTJ trial for 4 cycles as I am this weekend as I am out of town :-/
 
Re: Napa: Green then red now back down...yay!

Sure hope Napa does well without any insulin while you are away.

Have a safe trip.
 
Re: Napa: AM shooting dilemma

Looks like we made it through the weekend OTJ ok. The pet sitter was happy to give shots but q12 hour visits and testing was a lot to ask and since Napa's dosing is a bit of a moving target I decided to not risk it. I reasoned that a bit high for a few cycles was better than the small chance of too low.

We are sub-100 x2 this am after .25U last night. I am still shoot-shy after that ugly bounce. Stalled breakfast for an hour=cranky & hungry! I am thinking skip this am's shot and move down to .1U to see if I can keep the twice a day dosing even if it means slightly higher numbers.

These dilemmas are now the hardest part of this process. Thanks for any thoughts.
 
Re: Napa: AM shooting dilemma

You haven't updated your SS yet this morning. What was the AMPS?

I'll take a quick peek at your SS and get back to you.
 
Re: Napa: AM shooting dilemma

Oooopps. It was 84, I had typed it on the wrong line. Within 20% of the last test, tho. (Edited for typos.)
 
Re: Napa: AM shooting dilemma

Ok, a couple of choices here after looking at the SS.

1. Skip the shot this morning. If you have to go to work, probably the best idea.
2. Give 0.1U this morning. Leave out some extra food for Napa. She's unlikely to drop too low since the insulin depot is mostly drained.
3. Wait until this evening to go to the 0.1U dose.

You skipped 4 cycles of shots while your petsitter was taking care of Napa. That would have caused the Lantus insulin depot to drain almost completely. Numbers are still pretty reasonable, even with those skipped shots.

Yes, the TR protocol says 0.25U for a set 3-5 day minimum of time or 1 week at normal numbers, then reduce to 0.1U for a set 3-5 day minimum of time or 1 week at normal numbers (40-130) but not all cats follow the guidelines. Wink sure didn't.

You might want to try the 0.1U this PM and then if the numbers are getting higher, go back to the last good dose which was the 0.25U.

I think you may be getting very close to an OTJ trial.
 
Re: Napa: AM shooting dilemma

Thank you very much for your thoughts, Deb! Again :-) I can't tell you how helpful and reassuring you have been.

I am home most the day but I think I'll skip and monitor just to be on the conservative side. I, too, am cautiously optimistic about going OTJ.
 
Another sub-100 amps at 86. Good problem to have, I reckon.

I stalled one hour. Re-read yesterday's advice. Restest=96. Gave a what I hope was a skinny 0.1. The stopper moved ever so slightly but I could not definitively see daylight over the first black line using a magnifying glass. Practiced with water and my practice syringe--such a teeny drop.

Have to leave the house for about 2-3 hours mid-morning. Can and will test and feed at +2.

If I should move my posts of this nature to one of the other forums, please let me know. I know there other folks with much, much more serious problems here today as well as many others who are just getting started.

Warm wishes for good numbers from all the furballs and big thanks to all the experienced and generous advice givers working hard here.
 
Looking great!!

Those tiny doses are tough! Here's what .1 is supposed to look like, but it's more important for you to just be consistent with whatever YOU think .1 is at this point
01unit-1.jpg


Hopefully Napa will surf those pretty green numbers all day for you!!
 
Since Napa is on such a tiny dose right now, I'd like to suggest you regularly get that +2 test if you can.

If you need to leave the house for whatever, leave some food out so Napa can have a bite to eat to bring those numbers back up a bit if needed.

If you get a BG <50, it's an automatic reduction. That would mean the start of an OTJ trial, since there isn't much less insulin you can give that is lower than the 0.1U you are currently giving.

One week at these numbers, and its time for an automatic reduction too. AKA, an OTJ trial.

I see you shot a skinny 0.1U. Skinnying the dose looks like a real good idea to me right now. Better to err on the side of caution with these lows you are getting.

I'm almost tempted to say start an OTJ trial right now. What do you think?
 
Thanks for you for your thoughts, Deb. And thanks for the pic, Chris--that's just what my 0.1 looked like.

I waited to reply until I got the PMPS: 55. I was sorta anticipating a low number since she often lowest close to or at PMPS time (albeit with the limited data I have collected). Holding off on insulin tonight due to that number and >.< down to 2 strips. Plan to get a what would have been a +2 and normal time for AMPS then get more strips first thing in the morning.

I think we'll have to try OTJ at this point. I'll look around on the board to find recommendations about how long to keep those patience pants on and what criteria to use to call off the OTJ trial. I also need to decide when to follow up with my vet. I'd like to go back over the all the labs and decide what makes sense to re-do at this point. I am still a bit paranoid that there could be something more nefarious that has caused the diabetes.

But the Ps have been great too!
1. There are more puddles in the boxes but all a reasonable size and likely due to cats x2.5 now on wet food with a bit of water. Nobody cares about the fancy water fountain anymore, much less the shower floor lol.
2. Poop looks good, at least for Napa. Her sister is another story (BJM- if you happen to see this....thanks for that excellent constipation link in someone else's post).
3. Napa has played with her toys for the first time in a long while starting yesterday. She even went out of her way to knock over a paper bag to run into and hide in...classic Napa!
4. Preening-check!
5. Purring not so much...probably just paranoid I'll poke her. She'll jump up and hang out in my lap to surf the net with me, tail swishing here and there.

We're ever grateful for the support here.
 
If I were you, I'd not rush the OTJ trial. Only a week ago, you had Pre-shot numbers in the 400's, and just last night, a 202

I understand you not wanting to shoot tonight with the 55 at PMPS, but I'd see how she does on the .1 for at least several days before trying a trial. Generally, we like to see a week in normal numbers (50-120) before going down.

If you try an OTJ trial and the numbers start to go up,(anything higher than the 50-120 with maybe a little wiggle room) then it's a failed trial and you go back to the last dose that was working, at least to start.

Whatever you decide to do, Good Luck!!
 
Thank you, Chris. I need and appreciate that encouragement. You are probably right, but I'll have to evaluate in the am. It is still scarey for me shooting low even those teeny drops. I see how they do make a difference...I just don't know if I have enough of a feel for how its going to go.

Those dang 400s were likely a rebound/bounce from shooting on 2/3pm--well, no, not from shooting low but due to failure to monitor after shooting low. I've got some sleep issues that sometimes makes it hard to function in the middle of the night. I failed by banking on the previous night's +5. Don't want to chance that again.

My preference is to stick with 0.1 fat or skinny as much as I can without totally stressing while at work or trying to sleep, but shooting green is hard. Ironically, last night's 202 was a relief. I knew just what to do.
 
And....of course...out of strips and she comes up with a LO on the Relion. One tblsp of gravy and regular LC feeding. Not freaking out yet.

Manual says LO is 20 or less or not enough blood. We had a good drop and haven't had LO before, but she looks fine, albeit ever hungry. Will test again with last strip in a bit. Also have the CVS meter with a several strips as a back up. And Karo is next to the manual.

Note to self...don't friggin' run out of strips!
 
Did you give the shot tonight or skip it? It looks like you skipped it, but I just wanted to make sure.

Yes, test strips are a must. I start feeling panicky when I'm down to "only" two boxes (100 strips) left. :lol:
 
Yes, test strips are a must. I start feeling panicky when I'm down to "only" two boxes (100 strips) left.
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Good advice LOL. Walmart is a bit of trek and they were out of 100s when I bought the meter. I purchased the last two 20s that were left. Funny story--I stood in line at the Pharmacy (trying but failed to buy syringes with 1/2U marks) and the guy in line behind kept trying to tell me that Medicare would buy me a meter. I told him about 5 times that the meter was for my cat.. MY CAT, MY CAT...but he never really got it. Just kept shaking his head.

Yes, I skipped the pm insulin. Got a 97 on the last Relion strip. Whew.
 
Write off that "lo" as a bad strip, then. ;-) If you didn't give any insulin, it's highly unlikely (but not impossible) the residual depot would have brought on that LO.
 
hello, ellie. i haven't posted, but have been following along the last several days. that "LO" last night (i don't happen to think it was a bad strip/test) prompted me to pop in with a suggestion today.

how about trying what we call a "food trial"? in other words, you'd use food much the same as you've been using insulin. when you see a number higher than you'd like, instead of reaching for a syringe... feed a small amount of food and then test again 4 hours later to see if napa can bring her BG numbers down on her own. given a chance, i suspect she can and will. :mrgreen:

if she doesn't respond like i think she will you can always go back to giving her insulin. nothing lost.

alex and i have stuck around here and have been active in the lantus group for 7.5 years. in all that time i've only seen a couple of kitties who appear to bounce off the insulin they're producing themselves. i *think* there's a real good chance napa is another one. if she were mine, i'd check it out.

fwiw, just my thoughts...



Edited to add:
it's not unusual for a kitty to throw some higher numbers during an OTJ trial. don't panic. isolated high numbers don't mean a whole lot. feed a small amount and retest 4 hours later to see if kitty can come down on their own. during an OTJ trial we usually do not resume insulin unless we see an upwards trend. it's this upwards trend that we'll watch for when contemplating resuming insulin...
 
Thanks for your thoughts, Jill! Your description of the food trial makes a lot of sense.

I've been looking around reading info about OTJ trials in general.

One one hand, I don't *want* to rush it, given that we haven't yet met the criteria (unless that LO was indeed a LO). I am feeling better about drawing up teeny increments. My schedule for the next couple of weeks is fairly good for monitoring.

But on the other hand, I am really not all that comfortable shooting under about 80, even that skinny .1, especially at night or in the day if I have to be gone for more than a couple of hours. I'm not really sure what the "no shoot" number should be right now given my lack of data.

So, I guess I am sorta punting and taking it one cycle at time. Even tho she's only had a pretty small amount of insulin the past 4 days, I can imagine she might still have some in her system helping out right now. If you think the food trial is warranted despite not meeting the criteria (and I know nothing is set in stone with that), I'll definitely consider that, too. I've been feeding 4-5 meals a day and always when I test anyway. Maybe Napa will make it easy on me and just keep the numbers in my uncomfortable zone lol. I kinda doubt it, tho.

Thanks again for taking the time to send your thoughts.
 
I think we'll have to try OTJ at this point. I'll look around on the board to find recommendations about how long to keep those patience pants on and what criteria to use to call off the OTJ trial.
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We often let the OTJ trial run as long as possible, even to day 14.

I flunked Wink on his first OTJ trial on day 14. The numbers were higher than I liked, too many in the blue range. Plus, Wink was getting another UTI and a round of diarrhea which always tended to make his numbers go higher. Once he got over the diarrhea, he got a 2nd chance at an OTJ trial and passed this time.

I still do the occasional food trial, testing him around +3 to +4, especially if his numbers have been a bit higher with those AMBG/PMBG tests. I just want to make sure his BG's are coming back down after the food. So far, they have been, but it gives me piece of mind to test a bit more in a situation like this and see that he's still producing insulin on his own to counteract the BG rise from the food.
 
it's your decision, ellie. i wouldn't be concerned about "criteria" for a protocol Napa hasn't been following, but that's just me. the first time alex was on insulin she pretty much went from 0.5u to going OTJ... and stayed OTJ for almost 3 years. gingivitis knocked her out of remission that first time.

before the Tight Regulation Protocol was accepted on the FDMB, plenty of lantus kitties went OTJ on their own terms. just be careful. my concern is if that "LO" last night really was a "LO"... it's bound to happen again. note: ECID, but alex's "depot" almost always lasts for a full 5 cycles even on a tiny 0.1u dose.

good luck! we'll be rooting her on from the sidelines...
 
plenty of lantus kitties went OTJ on their own terms.
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Wink did the sugardance to his own drummer. We weren't following the TR protocol either.

He had his own ideas about starting an OTJ trial and it looks like Napa is trying for the same thing.

It's that ECID thing poking it's head up.
 
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