Morning!
I've been reviewing Terry's spreadsheet again, and I really think that 1 unit is too high a dose. She's getting 'tick mark' curves on it, drops at onset, jumps up after early nadir then spends second part of cycle at
higher values - sometimes much higher than the pre-shot level -before falling again at the end of the cycle. Granted, there will be food influences involved but it's hard to interpret the data better without seeing the feed times/carbs alongside the BG data.
For example, you look at the PM cycle for 26 July, the 1 unit dose dropped her BG like a rock by +3 and at +4 it was already rebounding. By +5 - within the period of Caninsulin peak activity - it has shot up 60 points higher than the pre-shot. That may be food-influenced, or it may be the liver dumping more glucose in response to the drop in the cat's blood glucose levels in the hours after the shot.
I'm also concerned about giving Caninsulin at such low preshot numbers - even at 0.5 IU BID (or even SID).
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I'm working on the assumption that your sitter is going to home test BG at AMPS and PMPS each day but is highly unlikely to test mid-cycle (as mentioned earlier in the thread).
With the eye issues in play, if Terry were mine I'd definitely want to consult my vet before briefing the sitter.
Looking at blood sugar levels in isolation, if Terry were my cat I'd ask the vet if the following strategy were OK:
1. Set a higher 'no-shoot' number for the sitter. (I'd suggest asking your vet about setting it at 200, and certainly not less than 180.) DEFINITELY keep the dose at - or below - 0.5 units Caninsulin.
2. Ask your sitter to ring you with the preshot test result every cycle before giving the go-ahead to administer the Caninsulin. (Plus agree with her about what to do if she can't reach you.)
3. How long is the sitter going to stay with Terry? Is there any chance of getting some +1 and +11 tests? They can be particularly helpful when mid-cycle tests aren't possible.
4. Ask your vet about maybe only giving insulin for the daytime cycle since a lot of cats run lower at night. It could be that Terry runs lower. Looking at her data, it's the AMPS that's highest. If she does have a natural tendency to run lower at night - and the data supports that hypothesis - you could take advantage of this to keep her safer since it should theoretically allow you to skip the PM dose without her numbers going too high. She's getting a lot of bang for her buck on the daytime doses as it is, and most of the time she's in the normal range for a healthy cat, even at 0.5 units of Caninsulin. (Great that you got the data last night!)
5. Most important of all, ask your vet how the concerns about Terry's eye health should influence her blood glucose management goals and therefore dosing strategy.
6. Make sure your sitter has the hypo guidelines printed out and ready to hand, along with Terry's different foods and honey/karo. Make sure the sitter knows which are low, medium and high carbs.
7. Agree a course of action with your sitter should Terry's appetite be a bit off (she might be missing you!).
Needless to say, your sitter will have your vet's contact details and emergency number. I'd also suggest maybe quickly setting up an FDMB account for your sitter so that she can post here for help if she can't reach yourself or your vet should an emergency arise.
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Those are things that I'd suggest you consider. If I were in a similar situation with Saoirse, I'd be looking to give the absolute minimum of insulin necessary to keep her stable and safe. That said, I am extremely cautious at the best of times, and that caution is several orders of magnitude greater when it comes to keeping my cat as safe as possible on insulin.
As an afterthought, is your sitter able to check Terry's pee for ketones at all? Might be an idea to grab some Ketodiastix to leave with her. (Belt 'n' braces and all that jazz.
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