New sugarcat in the block :)

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Elsa

Elsa

Member Since 2013
Hi everyone,

When at the end of June Miou -one of my 3 cats, was diagnosed with diabetes I was overwhelmed. Poor Miou was blind since age 1 and now she was diagnosed with her GLU >686 mg/dL !!!
I am from those wimpy girls that tremble at the site of a needle, and now I had to give an injection to my baby twice a day!!! A nightmare!
But the vet showed me how to administer the insulin and I got the hang of it pretty soon, but 12 days after we started the injections the doctor realized that the Lantus pen we were using was defective!!!
Trying to adjust to the new situation, and educate myself as much as possible, I stumbled on felinediabetes.com. I was wondering if one can home test BG for a cat like people do. Thanks to the instructions, and the videos here, I managed to test Miou's BG. Well it took me almost 10 days to manage to do a test without destroying 2-3 strips, but I have finally started managing my stress. Miou's stress levels are getting better too, now that we are not going to the vet.
Unfortunately it seems my Miou is a difficult case and still her sugar levels show no sign of being regulated. Her BG is all over the place. I guess the rule the vet is following has nothing to do with what I read here.
I was very shy to register and write on the board but I realized that it's the only way to thank you guys for the info you give and to help my cat with regulating her diabetes.

thank you all :smile:
Elsa
 
Hello and welcome to the board!

You have made a great start by home testing and lantus is a great insulin. What food are you giving right now?
Diet is key to regulation and you want a low carb wet canned under 10% calories from carbs like fancy feast classic pâtés, friskies pâtés or wellness grain free. Dry is too high in carbs.. Even the vets stuff.

Ok looking at your sheet I see a few things..

First the key to lantus is consistency. It is a depot insulin and any dose needs 3-5 days to build up to the correct level (or drain to the new one if a decrease) before you really see an impact. So i would recommend you hold the 2 units for the next few days to see how it really works. Unless she drops under 50 in which case an immediate decrease of 0.25 is needed,

Second, dose changes are actually made on the "nadir" or low point of the day..not the starting point since you don't want that low point too low!! So it's important obviously to get tests before you shoot to make sure you don't shoot when she is too low but also we recommend a mid cycle test (5-7hours after morning shot) and a before bed test (2-3hours after evening shot) if your schedule allows. This gives more data to see what she is really doing.

So let's see how she does over the next few days, keep at the 2units, get a few more tests in and keep us updated and we can go from there.. Oh and let me know on the food!! Or if you have other questions..

Wendy
 
Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given

first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if

not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins

(Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the

urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Diabetic control may be difficult to accomplish if you are feeding a higher carb food.

Good nutrition info, plus a comprehensive food chart with details for numerous foods are available at Cat Info
 
Hi Elsa and sugarkitty Miou and welcome to the FDMB. Lot's of experience here to help you with Miou to get her feeling better.

Please, ask all the questions you need to. Don't be shy about it, we'll help you in this new sugardance you and Miou are doing.

Lantus does better with a consistent dose, as Wendy said.

Does Miou have any other complicating medical issues?

Are you still using a Lantus pen? Are you using insulin syringes to withdraw the dose? That is best for the tiny doses our little kitties need.

Your signature indicates you are feeding Purina DM dry. Is that correct?
 
Wow thank you guys for all the welcoming
Miou says hi too and does the pawdance :RAHCAT

I will try to answer everything and start from the last question Deb asked, yes indeed I am feeding Purina DM dry.

I really wish I could be feeding wet food. But I am unemployed and with the crisis we have here in Greece, cat food is really expensive, especially wet. We have different brand names and I get all confused.

Wendy you told me about Friskies pate - well we do have Friskies brand here, but I was under the impression its not good! It has a bad reputation here in Greece, about additives! Anyway if its good, its also quite affordable, even more than the vet prescription dry food, and could be a good solution for all my 3 girls.

If I cannot find a solution with wet canned food maybe I will start cooking for them... anyway I will read study the catinfo.org BJ suggested and I am sure I will manage to find something more suitable.

As for the insulin, yes doctor was adamant about Lantus, he said there is no better for the cats. But Miou started really high, as I was not familiar with diabetes symptoms and we went to the doctor when she was really high and probably was diabetic for more than an year.

Wendy you suggested a dose of 2, but I read your post a bit too late and have gone on with 3. Also her BG was >300 so I thought 3 was ok.
About measuring BG, all the AMPS and PMPS I posted on the SS I guess are what you named starting point, right?
So what time is the nadir, is it between +5 to +7 ?
Is the nadir the same with what I read on other posts as peak?
BJ that reference range is quite handy

Wendy I use the pen, I would love to try the syringe, since going down by a whole unit seems too much, but not sure what I should get from the pharmacy. Are the needles as small as that of the pen? Because I think I couldn't manage it if the needle is bigger.

Also Miou's diabetes was diagnosed when I took her to the doctor about her inappropriate urination. She would pee herself in her sleep and not bother about it... Doctor immediately checked for GLU... and bingo. But she had a urinal infection which we treated with antibiotics and is now ok. Since then she uses her sandbox regularly, except when she wakes up from deep sleep then she urinates in front of the bedroom door, or the toilet door! To me she seems as if she doesn't understand where she is... the doctor on the other hand says its psychological and she does it because she is depressed and that it has nothing to do with diabetes now that she is on insulin!
Has anyone had a similar problem? I read about the urination info on the site but I wonder is she still under the "sugar spell" or is the doctor right?

I should go now and do some cleaning, I must have overwhelmed you with my questions.
Thanks for all the info, I will try to do all the "homework"

Elsa & Miou
 
The nadir is the lowest glucose level, usually between 5 to 7 hours after a Lantus shot. It is when the insulin reaches its peak effect. Testing during that 5 to 7 period will identify how low she goes so you can adjust the dose.

Lantus is a 'depot' insulin. You inject it, it forms little crystals/precipitates, these slowly dissolve, and release the insulin to work.

A consequence of uncontrolled diabetes for a sustained period of time may be diabetic neuropathy, where the high glucose has damaged the nerve functioning. Usually, you may see this as difficulty standing and walking, with an inability to fully straighten the legs. It is possible that the neuropathy affects the bowel and bladder nerves, resulting in difficulties with control of elimination. This may result in accidents. Methylcobalamin, a specific form of Vitamin B12, helps restore nerve function in addition to controlling the glucose.

Her bladder may fill very full with the high glucose and she may not be able to make it to the litterbox in time.
 
You can use a standard U-100 insulin syringe to withdraw the insulin from the pen. These syringes have very fine needles - 30 or 31 gauge - and can have half unit marks which make it easier to meaure doses. We routinely eyeball quarter unit increments in dose, since those aren't marked. If you can find them, look for 3/10 cc (mL), 30 or 31 gauge, and short or long needle. I preferred the 5/16 short needle myself; others prefer the half inch long needle.

You just remove the cap with its needle, and draw it out with the syringe. Because of the pressure mechanism in the pen, you do not inject air. Any excess insulin in the syringe is discharged as waste, so that the syringe lubricants do not contaminate the pen.
 
We think Lantus insulin is absolutely the best for cats too!

I feed my cats the Friskies pate style foods as well as the Fancy Feast classic pates. Not the best quality, but very affordable and my cats are doing well on this food.

Would you be willing to please update your user control panel, profile tab, edit profile, location and put Greece in the location field for us. That will help us to know what time zone you live in, in case there is an emergency and need help.

So what time is the nadir, is it between +5 to +7 ?
Click to expand...
Some cats nadir very early, some cats nadir very late. 5-7 hours is an average. My cat Wink had a nadir around +4.

Is the nadir the same with what I read on other posts as peak?
Click to expand...
Yes, nadir is also called the peak because that is when the insulin has it's greatest effect and the BG (blood glucose) will be at it's lowest point.
 
ok I guess that Miou's nadir is at +7
I measured her BG at +6 and it was 290, while her PMPS BG was 197
I will measure at +7 tomorrow and see
 
Hi Elsa, welcome! The nadir is the lowest glucose value during a cycle. For the readings you mentioned, it is 197, which was at PMPS. My kitty does that sometimes, that is, has a nadir at the end of the cycle. In fact, he did it today.

donaleen
 
Nadirs vary as you just found. Typically it's at 5-7 but that's assuming there isn't a bounce going on and I suspect that's what you saw today..


Bounces - what are they and is my cat doing them?
When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
 
Wow now I understand what is going wrong with Miou's BG... this bouncing is quite visible in her chart... I have to run atm, I will post it asap
 
Lantus works best, if you can be consistent with the dosing. The 5U was obviously too high and your vet did reduce it. You have been dosing the Lantus with frequent changes, never staying with one dose for more than a few cycles. From a note on your SS, it appears that your vet told you to dose the Lantus based on a sliding scale.

Some of the older insulins like PZI, Prozinc, Vetsulin, Caninsulin, Humulin/Novolin N are dosed this way, changing the dose based mainly on the pre-shot, but that is not the correct way to dose the newer insulins like Lantus or Levimir.

Lantus is a depot type insulin. By constantly changing the dose, you are filling and draining that depot and you are not seeing the smooth, gentle responses that Lantus is known for.

Lantus dosing changes are based on the nadir, or lowest point in the 12 hour cycle. You need to get some tests in that +4 to +7 hour time frame to see what is going on.

We also do not recommend making dose changes in 1U increments. It's better to make smaller dosing changes, in 0.25U increments.

With that low of 88 this AMPS, I'd suggest getting another test ASAP. That 3U may be too much and drop Miou really low.
 
Deb this must be the case with the dosing the doctor has suggested.
After Wendy's last post about bouncing I realized that this sliding scale dosing as you mentioned keeps Miou's BG on a constant bouncing mode!
One can see the constant bouncing here on the chart I promised earlier. (red line is her BG, green is the units injected and blue line the food intake in grams.)
I didn't reduce the AM shot and gave her 3U based
a. on the reference ranges BJ posted the on the 18th in this same thread
and
b.As you all have suggested I aimed to be more persistent with the dosaging.
Reducing was what I have been doing everytime she dropped under 100
I wouldn't do it if I was not home to monitor. Anyway no reason to worry she is fine and her +7 BG a few minutes ago was 272!
I didn't catch her at the nadir, or she has not reached it yet!!!
The fact that I can't find her nadir frustrates me a bit, but I will go on trying.
In a couple of hours I will meet with her doctor, to show him her chart.
 
Elsa said:
...The fact that I can't find her nadir frustrates me a bit, but I will go on trying....
Click to expand...

The nadir is only approximate as it can move around. Just get mid-cycle tests in the expected time frame.
 
As long as she is bouncing her nadir will be all over the place. You need to get some more tests in - like before bed and spot checks at other times- to see how low she is going during her cycles because she may be dropping too low which is causing these bounces. for example last night she may have dropped way below 88!

Wendy
 
I also use Friskies Pâté, it has been wonderful. My vet did not seemed concerned about additives, and I think low carb/high protein is a higher priority for diabetic cats. Good luck, and way to go for overcoming your aversion to needles!
 
Hi again everyone,

I visited Miou's vet yesterday and we had a long talk. I shared with him all that I learned here and he listened carefully.
He agreed about the bouncing effect but had no idea how to overcome it. He also told me that he trusts forums that are so specialized, and suspects that you guys may have reached a level of knowledge about diabetes that he lacks, he has treated just a handful of diabetic animals, that were way more easier cases comparatively.

We compared notes about the Lantus doses. He had a study about glargine, that was suggesting the following and is what he has followed in the past.
It states dosaging according to nadir but also PS BG and since finding the nadir is kinda difficult it might help.
I noticed that the nadir dosaging is pretty close to the one BJ wrote, so I hope the PS numbers help me.

  • if PS BG >360 or nadir BG >180 ---------------> then increase by 0,5 IU
  • if PS BG 270 - 360 or nadir BG 90 - 180 -----> then stay with the same dose
  • if PS BG 198 - 252 or nadir BG 54 - 72 ------> then stay with the same dose or it may indicate a decrease by 0,5IU depending on water intake and urine amount
  • if PS BG <180 or nadir BG <54 ----------------> then decrease by 0.5 IU

I would love to have your feedback on this.

I also realize that I have to go and get insulin syringes as I would pretty soon neet to use the half units. Now I fount the pictures and stuff that is posted on the forum about them and you have already told me how I would draw, but I need some info on what I will ask at the pharmacy. I am guessing I will need syringes that are for low IUs. The doctor had some that were for 100 IU, making it almost imposible to draw the tiny amounts our cats need.

For the time being I am waiting out the bounce staying with the 3U, though I am sure I will soon need to decrease.

----edit
I read in other posts that I should get the 3/10cc syringes with half unit markings, like BD Ultra Fine 3/10cc short
I am heading to the pharmacy right now to see if I can find one.

It seems I might need it sooner than expected
today we started with AMPS of 210 and after food and shot at +2 she was at 71 and at +6 at 109
I really don't know if I should stay at 3 or go to 2.5
spreadsheet is updated, if you like to take a look
 
I had no luck with the syringes, I went to 4 pharmacies...
I will visit some more central pharmacies tomorrow. I hope I find something...
 
Now that you're past the initial dose, you may evaluate your test numbers with either the Tight Regulation protocol or the Start Low Go Slow protocol.

Because Lantus has a depot/carry over effect, it is helpful to wait about 3 full days on a dose (unless you go below 50 mg/dL), then evaluate your mid-cycle tests to see how low the cat is going,

The reference ranges I posted earlier may be helpful, too. Any time your low value is below 50 mg/dL, you may reduce 0.25 units. You'll have to eyeball that increment as the syringes don't mark them. Also, we increment Lantus by 0.25 units too, so as not to miss the optimal dose.
 
Elsa said:
I had no luck with the syringes, I went to 4 pharmacies...
I will visit some more central pharmacies tomorrow. I hope I find something...
Click to expand...

What you might ask for are the insulin syringes "for children." They might have them and not even know it.
 
That study your vet had sounds like the old version of the Roomp and Rand protocol which we use here. It's been modified since, so the dose changes are done in 0.25U increments instead of 0.5U increments in most cases. There are exceptions of course.

The lower dose changes were felt to be safer for people monitoring their cats at home. The thought was not to take them too low, and become hypoglycemic.
 
KPassa said:
What you might ask for are the insulin syringes "for children." They might have them and not even know it.
Click to expand...
You may be right, they indeed don't know anything. Today I went on with the quest for the syringe, one pharmacist insisted one Unit is when you fill entirely the 0.5 syringe(!), an other one made fun of me and said that I should not expect to find a 3/10cc syringe, and that BD might have that one only in the US... I finally found a pharmacist that understood what I was looking for, could differentiate between a IU and an ml, and was willing to order them for me, since he had not any at the pharmacy, but unfortunately the wholesaler had not any atm.
I will have to wait... I hope not for long.

Deb, thanks about the info, I found the Roomp and Rand protocol and saved it to send it to the doctor, he will be very happy.

FosterMomGoldie said:
I also use Friskies Pâté, it has been wonderful. My vet did not seemed concerned about additives, and I think low carb/high protein is a higher priority for diabetic cats. Good luck, and way to go for overcoming your aversion to needles!
Click to expand...

I checked the list from catinfo, and the sites of all the cat food brands, and realized that the Friskies pate you guys have there has nothing to do with the Friskies we have here.
 
Dr Pierson notes that you may add 1 oz of plain poultry or meat to every 5 oz of a canned food and that will improve its protein, fat, carbohydrate proportions.
 
I am in great distress, I have not yet found any syringes to give half units to Miou.
My test strips are running low and I can't get any new ones until Tuesday. So from yesterday I can' even spot test, I have enough strips only for pre-shots

Her PMPS was 62 today and I can't decide what to shoot :?
I have no nadir to reference
the old Roomp and Rand protocol I have states that if PS is <180 then decrease by 0,5... in the new that would be a 0,25, but I still don't have the means to shout halfs let alone quarters...

---- edit---
She has been on the 3 units steadily for the past 4 days. What scares me is that if I give 3 she might go hypo and I have not enough strips to check her
I will give her a 2 better safe than sorry

I would appreciate any advice on what to do on her next shot

Btw I have changed her food to Kippy wet food since last night...
 
When I get to the office, on a PC, I'll get you my write up on how to create a syringe reference gauge.

ETA: Here you go - How to Make a Reference Gauge. Nice to know that high school geometry actually has a purpose!

If nothing else take a sturdy ruler with millimeters marked, line up the bottom of the syringe barrel with 0, and count up how many mm it takes to measure a full unit.com Then use your closest approximation to half of that. It may not be an exact volume, but you will have something to help you be consistent in measuring.
 
That is mighty helpful cause it looks I will have a hard time to get 0,3 with half unit marked

Anyway I will get syringes on Monday since pharmacies are closed now...

Do you think that it was wrong that I gave a 2 in the morning?... (a decrease if a whole unit)
 
You'll see the impact when you test. If it was a good move, numbers often look better.

We prefer to change doses in increments of about 0.25 units, so we don't miss a good dose. You do have to eyeball it, as no syringes measure that minutely.
 
Elsa said:
Do you think that it was wrong that I gave a 2 in the morning?... (a decrease if a whole unit)
Click to expand...

This was with a 68 pre-shot? We don't recommend shooting under 200 until you have the data to show it's safe. This has me concerned. Are you around to monitor? I know you're running low on test strips, but you can use BJM's Secondary Monitoring Tools.

Looking at your spreadsheet, it seems there have been quite a few low pre-shots since you started testing. This is usually indicative that the dose is too high. You're also giving some inconsistent doses. Lantus works best on holding the dose stable. A suggestion going forward would be to hold the 2u dose for the next few days and see how Miou does on that dose. You do not want to see numbers under 50 (automatic dose decrease) or too many pre-shot numbers under 200 (another sign of needing a dose decrease).
 
My sweet Miou had a lucky day today, :RAHCAT
a few minutes ago my brother came home and brought me the 0.3 syringes he found at a pharmacy near his place. (yeap I head the whole family searching)

So now I will test her and let you know :smile:
 
Uh oh!
She is at 32!!! Thats her PMPS
she is eating atm
I am holding the insulin for the moment and would appreciate your advise

I have to add that she has been purring and following me and my mom around in the house.
She seemed only a bit more hungry than usually.
Should I give her some honey too?

I am panicking I will post a new thread. Sorry if this is not right.
 
I replied on your other post but I wanted to repeat some of what was said in case you haven't seen it yet. Yes, give a little honey because we don't know if she has further to drop just yet. We want to get her numbers at least above 40. You will need to monitor her for the next hour or so until you see a rising number that is not propped up by HC food/sugar.

New post here.
 
No insulin.
Possible hypo.

Give small doses of honey or syrup every 30 minutes, re-test, and continue until up above 100.

NO KIBBLE - it won't work fast enough.
 
The day after the Hypo

I am continuing here with my updates after the 911 thread I posted last night. I am not posting there, as I haven't found a way to take the 911 icon off, and I don't want to give false impression by bumping it on the board.

So Miou was doing quite good last night. I was a bit insecure though as I had no strips to test her. She wanted to sleep but I woke her up quite a few times to check on her, and also moved a ribbon near her face (she is blind she she was 1 y.o) to play. She responded by playing for a while with it.

At 03:00 (that would be her +5 if she had a pm shot) I fed her again a bit of her wet food with flour to be on the safe side. I didn't add any honey
I fed her again just a bit at about 06:00 (here +8 if she had a pm shot) only plain wet food, no honey or flour in order not to bump her BG up too much.

I got some strips from my diabetic friend but as she refused to take anything back, I was ashamed to ask more than the ones I need for the pre-shot tests

Her AMPS was 272, I guess it was a bit high after all this food and honey and flour... but as BJM said, better a day too high than a moment too low
I gave her a shot with 1u as we had planned and she is doing fine.
 
To remove or change the icon, go to your 1st post on the thread.
In the upper right corner of the post is an Edit button.
Click on that and make whatever changes you need to make.
Submit.
 
The flour might take up to 24 hours to clear her system and she could also bounce for up to 72 hours due to the low..(bounces explained below). Dont panic though this is normal.. hold the 1 unit dose for 3 days (unless she goes under 50 again) and let the bounce clear before we look at dose again.

Bounces - what are they and is my cat doing them?
When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
The insulin depot - what it is and why it effects your cat’s BG numbers.

Wendy
 
BJM said:
To remove or change the icon, go to your 1st post on the thread.
In the upper right corner of the post is an Edit button.
Click on that and make whatever changes you need to make.
Submit.
Click to expand...

ohmygod_smile I must have gone half blind from not having enough sleep... it was right there lol
Ok done now :)
 
Wendy&Tiggy said:
The flour might take up to 24 hours to clear her system and she could also bounce for up to 72 hours due to the low..(bounces explained below). Dont panic though this is normal.. hold the 1 unit dose for 3 days (unless she goes under 50 again) and let the bounce clear before we look at dose again.

Bounces - what are they and is my cat doing them?
When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
The insulin depot - what it is and why it effects your cat’s BG numbers.

Wendy
Click to expand...

Yeah I am sort of expecting a bounce... I had no idea that the flour could take up to 24 hours to clear though!!!
... whatever the case I will wait it out.
 
KPassa said:
You did fantastic last night! Great job! And Miou is none the worse for wear. :-D
Click to expand...

Miou and I thank you a lot, actually we did fantastic because of the great help you people gave us.

So I am happy to announce that Miou's PMPS with only 1u in the morning was at 133.
So according to the plan she is not getting a shot tonight either...
You also had mentioned that
You also want to reduce the dose any time you miss two or more shots because of too low a pre-shot number.
Click to expand...
Do you think I should reduce for the next shot? or just go on with 1U if she is above 150?
I do have the 0,3 syringes with the half unit markings if needed to go lower
 
I would hold the 1 unit a little longer because she might still have some extra insulin in her system from the prior 2 units.. So I would give 1 unit tomorrow if she is over 150.
 
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