Need dosing help

Do you think his bounces are ending? Or have I misunderstood? I wish his hypo numbers were.:arghh:He's gone down to 2.3 today. It seems that every time he has insulin now, he gets those really low numbers and I just don't know how much to give him. even when he was at 20.0 for the pre-shot this morning, he managed to go down to 2.3 this afternoon, so I don't know what to give him if he's lower. Just tested him and he's 6.1 at PMPS. It's now 8.30pm and if I wait another 2 hours, it'll be 10.30 which is making a bit late for tomorrow morning. if he goes up a bit say to 7.0 or 8.0 in the next hour, would those numbers be high enough for 1.25 u ? Sorry to keep asking.
 
You did the right thing in dropping to 1.25 u because of that lime green. Get a +2 to see where he's going.

Re bounces: it's a very common phenomenon and you have to learn to tolerate them. ;)
 
Oh for the love of Bastet! He did it again!?!? Okay, no more big dose changes. He's clearly a kitty who will have an out-sized response. Baby steps and patience now if he needs his dose to change.
 
I didn't get the 2 hour but I tested him at 3 0am and 5 0am and he was high 20.6 and 19.7 and this morning 19.8. Haven't dosed him yet because he's not due till 10.0am (in an hour and a half) but I haven't got a clue how much to give him now, I gave him 1.25 last night when he was 15.9. I need your help!!!! :confused: Thank you as always
 
Checking: did you give 1.5 u this AM? I think that lime green yesterday tells us that he needs a reduction to 1.25 u. Test again at +2. As a general rule, if a dose produces a lime green you reduce by 0.25 u and stay at the reduced dose. Even if the following numbers are bounce-elevated you keep the new reduced dose. It would be increased again only if several cycles of data prove it's too low.

Yes, this is tricky, especially when the insulin needs are dropping fast. Always safety first. :)
 
I gave him 1.50 this morning (very slightly under) because I didn't see your message till this morning and I wasn't sure if a higher number needed a higher dose, but tonight I'll give him 1.25 again. So far he's stayed higher today, but he's got another six hours to go yet before his PMPS so he's still got time to get a nice hypo number again! I do hope not! Thanks very much for the information.
 
PatJ said:
I gave him 1.50 this morning (very slightly under) because I didn't see your message till this morning and I wasn't sure if a higher number needed a higher dose, but tonight I'll give him 1.25 again. So far he's stayed higher today, but he's got another six hours to go yet before his PMPS so he's still got time to get a nice hypo number again! I do hope not! Thanks very much for the information.
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The low BGs are much more important is judging the effect of a dose. If you see a lime green today, try 1.25 u tonight. If that produces a lime green drop to 1 u, and so on.
 
Kris, I'm so sorry to keep on asking, but at what dose is it high enough to shoot 1.25 because I've been stalling for up to two hours so that the number gets higher, but is it safe to give him 1.25 at 7.0mmol/L or above or should I wait till it gets to about 9.5? Just wondered if a lower dose is all right for a lower number?
 
PatJ said:
Kris, I'm so sorry to keep on asking, but at what dose is it high enough to shoot 1.25 because I've been stalling for up to two hours so that the number gets higher, but is it safe to give him 1.25 at 7.0mmol/L or above or should I wait till it gets to about 9.5? Just wondered if a lower dose is all right for a lower number?
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I think this is close to what I recommended in the past:
  • if close to 11 (maybe 10 and above), stall without feeding for 30 minutes and retest. If BG has risen try the full dose.
  • if in the 8 to 10 range, try stalling up to an hour and if rising do the above. If BG isn't rising much give a reduced dose. How much to reduce is always a conundrum. Maybe try a 2/3 dose.
  • if BG is much lower (say, 6 to 8) give token dose - size depends on what the normal dose is. Only do it if you can monitor. You can be braver with this once you have a lot of data. It's best to avoid skipping if you can but sometimes that's the safest thing to do.
Those guidelines apply regardless of the size of the dose. It's the response to the dose that's important. For example, a dramatic response to a tiny dose warrants caution whereas a very small response to a big dose means you can give the full dose without worrying - generally speaking. There are no carved in stone rules. It depends so much on the individual cat's patterns.

In a nutshell - no, I wouldn't give the full dose (which happens to be 1.25 u at this point in time) on a PS of 7 mmol/L. This is a "token dose" situation. If the full dose is 1.25 u a token dose *might* be 0.5 u or less. That's a guess and it has to be tempered with kitty's recent history, your ability to monitor, etc.
 
My cat was getting nice low numbers on 1.25u (except for the hypos) but now he's gone higher again and I wonder how many cycles I should leave it at 1.25 u before I up the dose again. I'm a bit worried in case he's on too low an insulin dose now? Would be glad of some help! Thanks.
 
I think I would leave the dose for tonight, and then see if you need to increase tomorrow morning. And if you decide he needs an increase, I would try to do it in very small baby steps. So aim for a "fat" 1.25u, then a "skinny" 1.5u, and then the regular 1.5u (if he needs to go that far up). And hold each baby step for at least two cycles. He's had a lot of hypos lately, so I would be cautious with any increases. It does seem surprising that he's suddenly so high which is why I'm suggesting keeping the dose one more cycle first and seeing if he corrects. With the "no shots" and the dose changes, he's been moved around a lot lately, so a couple of days of stability could be helpful.
 
Thanks Djamila. You did warn me that he might go up again and unfortunately you were right! Thanks very much for the advice.
 
this is probably a silly question, but do you have to wait for the BG numbers to rise again before you can give a shot or just make sure that the numbers are shootable at the time of the dose? I just wondered if it makes them have hypos if they are still going down and then they get more insulin. My cat keeps dropping all the way to the end of the cycle these days.
 
PatJ said:
this is probably a silly question, but do you have to wait for the BG numbers to rise again before you can give a shot or just make sure that the numbers are shootable at the time of the dose? I just wondered if it makes them have hypos if they are still going down and then they get more insulin. My cat keeps dropping all the way to the end of the cycle these days.
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Generally, give the dose if the PS is high enough. Even if the BG is at its lowest at PS (but high enough to give the full dose) the previous dose of insulin is likely near the end of its duration so you can give the new dose. If the PS is the lowest and near your "reduce dose" or "no dose" number more caution is required. It's hard to predict what might happen so you have to do some experimenting provided you can be around to monitor and give snacks if needed.
 
He's been quite high today and then suddenly started to drop to 13.6 two hours before his PMPS then it was at 7.2, so I waited for it to go up and it went down to 6.5, waited again and it was 5.4:arghh::arghh: If I wait for another hour it will be after 10.0pm and that puts his schedule right out. I had the syringe filled with 1.25 units now I don't know what to do for the best. This is driving me up the wall. He just seems to carry on dropping even past his shot time. For all I know he's gone even lower so had better go and test him again. Should I give him high carb food at the time I test him in the evenings (if he's low again) so that his BG goes up and he can have a shot, because it really worries me when he misses a dose like this and it seems to be happening a lot lately. Sorry to bend your ears like this Kris.
 
PatJ said:
He's been quite high today and then suddenly started to drop to 13.6 two hours before his PMPS then it was at 7.2, so I waited for it to go up and it went down to 6.5, waited again and it was 5.4:arghh::arghh: If I wait for another hour it will be after 10.0pm and that puts his schedule right out. I had the syringe filled with 1.25 units now I don't know what to do for the best. This is driving me up the wall. He just seems to carry on dropping even past his shot time. For all I know he's gone even lower so had better go and test him again. Should I give him high carb food at the time I test him in the evenings (if he's low again) so that his BG goes up and he can have a shot, because it really worries me when he misses a dose like this and it seems to be happening a lot lately. Sorry to bend your ears like this Kris.
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Definitely no shot tonight. The fact he's still dropping and the last BG is too low for insulin makes this the right choice. Don't fiddle too much with the feeding schedule and don't extend the stall and retest beyond an hour. If after an hour of stalling without feeding the BG is below 6 that's a definite no shot. Give 1.25 u again tomorrow. If you run into the same problem tomorrow evening drop the dose to 1 u AM and PM. The goal is to get two PSs high enough to give insulin.
 
I'll do what you say and keep everything crossed that there's not a repeat performance tomorrow night! Can I just double check that if even if he's still dropping, it's OK to give him a shot as long as the BG is high enough at the time? Thank you again for all this help. I really do appreciate it.
 
That dark green at +2 after a no shot is interesting. There was very long duration from that AM dose. Let's see how he does today with the 1.25 u. If you run into the same issue this evening a dose reduction might be in the cards.
 
Hi Kris, He hasn't gone low at all today because of not having had a shot last night, so I hope he has some better numbers
tomorrow. I'm hoping that he's not going back to high numbers again but another couple of days hopefully will make a difference!! Thanks for looking in on him.:)
 
PatJ said:
Hi Kris, He hasn't gone low at all today because of not having had a shot last night, so I hope he has some better numbers
tomorrow. I'm hoping that he's not going back to high numbers again but another couple of days hopefully will make a difference!! Thanks for looking in on him.:)
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Those pinks are a big bounce from dropping low. Keep 1.25 u tonight.
 
I've absolutely mucked up William's numbers today by just giving him 1.0 u because he was at 18.7mmol/L and because I didn't think that I'd be here all this afternoon I didn't want to risk being not here if he went too low, but he's gone higher than he was this morning and I was here, so I should have given him 1.25 after all and now I wish I had. Will giving him 1.25 tonight mess him up too much? Would be grateful to you for an opinion.
 
PatJ said:
I've absolutely mucked up William's numbers today by just giving him 1.0 u because he was at 18.7mmol/L and because I didn't think that I'd be here all this afternoon I didn't want to risk being not here if he went too low, but he's gone higher than he was this morning and I was here, so I should have given him 1.25 after all and now I wish I had. Will giving him 1.25 tonight mess him up too much? Would be grateful to you for an opinion.
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We all make boo boos, Pat. No harm done, just bump him up to 1.25 u at next shot time. :)
 
I am a bit worried that William's numbers are going higher again today, because last night when I gave him a token dose, he had lovely numbers all night and yet when I gave him the same dose this morning because he wasn't high enough to give a full dose, his numbers are going much higher. Does it mean that he hasn't had enough insulin? Hope you don't mind, but could anyone tell me if I should have given him a higher dose this morning? Thanks very much.
 
PatJ said:
I am a bit worried that William's numbers are going higher again today, because last night when I gave him a token dose, he had lovely numbers all night and yet when I gave him the same dose this morning because he wasn't high enough to give a full dose, his numbers are going much higher. Does it mean that he hasn't had enough insulin? Hope you don't mind, but could anyone tell me if I should have given him a higher dose this morning? Thanks very much.
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He's probably higher because of bouncing after that lime green as well as having a lower dose this AM. There are no carved in stone rules for what to do - only very general guidelines like the ones I gave you about handling lower PSs. These trial and error experiments give you the data you need over time to learn how much you can push the envelope. As long as you're at home to test and steer with food as needed you can try to be a little bolder with dose next time.
 
Thank you for your advice, Kris. I've got the high carb at the ready, so if he's low again at PMPs I'll see what happens tonight.:)
 
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