Newbie, help with dosing ASAP

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Catannc

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HI,

Kitten's preshot has dropped from the am 30 points as expected, and don't doubt it will tomorrow am as well. Now 333 and tomorrow expected 303. Check her table, pm response must have a much later nadir or very gradual onset as I don't see the drop, in 4 hours pm she will only drop 40-50, 4 hours am she will drop about 260. Alter dosage at all tonight, or deal with it in the morning?
 
Why not stick with the .5u dose but can you split the pm meal into 2? give half at shot time and then the other half at about +2 or +3?
 
Is her feeding schedule and amounts fed the same AM and PM?
 
What has me confused is that red AMPS yesterday. Looks like a bounce, so maybe she went low the night before, later in the cycle?

The last time you shot reduced PM (.33), it doesn't look like like much happened for 4 hours, but something had to happen after that to cause the high number in the morning. Or it just wasn't enough insulin so she climbed that high by morning?
I think the .5 tonight is okay.
What's everyone else think?

Carl
 
Those reds came on days when i "fed the drop", so I am assuming the extra food at +3 to +4 kept her up, along with the reduction to .33 units caused that red AMPS yesterday.
 
Went ahead with the .5 tonight, but I think I will get up and check her to see what's going on at night time +6 since she hasn't been showing the same response as the morning.
 
I don't see why you don't stick with the .5u does and just spread out the meal you give at ps time... don't give it all in one meal; divide the amount into maybe 3 small piles. Give one with the shot and then one at +2 and the 3rd one at +4
 
The concern to me is that if today's and yesterday's AM cycles are what .5 will do for her, and the PM cycles aren't showing the max effect of .5, then you may have to feed the drop if you give her .5 into the lower 333 tonight. There isn't a whole lot of difference in the doses, but she looks pretty sensitive to small doses.
Carl
 
well, breaking her meals up tonight won't really do much as she only will drop about 45 points total in the next 4 hours. What concerns me, along with Carl, is her tendency to drop 260 on the same dose and same food in the am. And the pattern of each preshot moving right about 30 points lower. So hypothetically, if tomorrow she ends up PS 303, I can expect that she might be around 40 at 4+. Way too low, and I will only be home up to 2+. So in this scenario, what would you do?
a. I can feed at 2+ before i leave, she will probably be at bout 200 then.
b. I can reduce the insulin to about 1/3 unit, I'm still on U-40 syringes so I can't get super accurate.
c. I can shoot a light .5 unit and feed at 2+.

Cathy
 
Of those three options, I'd probably choose the slight reduction, and I would leave a bit of food out when I walk out the door. Assuming you get the AMPS you anticipate. If she throws you a curve ball, post her number. There's usually a good sized crowd here between 6-8 am (eastern). Bring coffee!

Carl
 
Catannc said:
well, breaking her meals up tonight won't really do much as she only will drop about 45 points total in the next 4 hours. What concerns me, along with Carl, is her tendency to drop 260 on the same dose and same food in the am. And the pattern of each preshot moving right about 30 points lower. So hypothetically, if tomorrow she ends up PS 303, I can expect that she might be around 40 at 4+. Way too low, and I will only be home up to 2+. So in this scenario, what would you do?
a. I can feed at 2+ before i leave, she will probably be at bout 200 then.
b. I can reduce the insulin to about 1/3 unit, I'm still on U-40 syringes so I can't get super accurate.
c. I can shoot a light .5 unit and feed at 2+.

Cathy

You can NEVER predict what will happen in the future, and making plans based on what you THINK the numbers will be are of no use.

Since you don't have U100 syringes, all of your dosing is just guesswork, so you can't say what you are shooting until you have the different syringes with 1/2 unit markings.

If you want to know how the food is working, do a test before food and 1hr later, every single time you feed.

You are pretty much in the same position as all others who are not home: they don't know what happened when they were away. You can't make assumptions that there will be a huge drop all the time, and the only way to slow a big drop is to have an auto feeder to have food available at prepared times to manipulate the numbers, to slow any drops.

as I have said, I don't know this insulin, other than to know it does not last a full 12hours for many cats so you can expect higher ps numbers.
 
I know no one can predict numbers, but having an idea of what to do if trends continue is helpful so I'm not on here at the last minute waiting for some help. I appreciate everyone's opinion and I know I have to wait to see until I even know if I have to change anything.
 
Gayle,
She did say "hypothetically" so she isn't betting money on it. Just a "what if" question based on her recent SS trends. And a "what if" answer to the hypothetical. Good idea to be prepared just in case she's at a loss and nobody is around to advise.

Prozinc's duration, according to their website is 10-14 hours in cats. Many cats on it here do get 12 hours. PZI, different story, but they claim 8-12 hours so many don't last quite a cycle. Several of our kitties in PZI routinely get longer than 12 hours from a dose. ECID, and with many cats, Every Cycle is Different, in terms of duration. Heck, if you visit the lantus website (of course, the info there applies to humans), they say it lasts 20-24 hours in people, so it isn't exact either.

Carl
 
Carl,
If if's were wishes .... I think you should have 3 or plans, you need to be able to decide at the time, and I don't think many base dosing half a day ahead because several factors are always in play.
To talk about drops of 40 does not carry much weight due to meter variance and any other number of things that come into play.

Prozinc/PZI are different, much different from Lantus/Levemir. The Ps do not last as long as the Ls and the Ps also have no shed, making for a less smooth curve as far as I have seen in many cases.

Feeding only 2 times a day will create havoc to BG numbers; ask any human diabetic what would happen if they ate only 2times a day.
I don't know how important dose measurement must be for the Ps, but it's pretty important with the Ls, so until you have a constant in place with the dose measuring, it's pretty tough to predict what the numbers may or may not do.

Spreading out food consumption and obtaining some U100 syringes will go a long way to help in any dose planning. Until then, it's all guesstimate and when it doubt, err on the lower side of a dose.
 
you need to be able to decide at the time, and I don't think many base dosing half a day ahead because several factors are always in play.

Gayle,
Kitty has only been on the juice for a couple of weeks, and just saw good numbers for the first time a few days ago. There is no "deciding at the time" or "3 or more plans" at this point. It is far too early to figure anything out for sure. I agree 100% about the "several factors in play". In fact, I think those "other factors" are far more important and controlling over the day to day curves than the food or the insulin shots we give. We like to think we have some degree of control over things, but that is all we will ever have is "some degree". But we do spend a lot of time on "what if" scenerios in PZI. It is extremely educational, and it's what peer review is all about, isn't it? Bouncing ideas off of one another so that everyone learns and is better able to advise in the future. People who have been here for a month or less teach me new things on a daily basis. Everyone on the board, no matter how long they have been here, is able to learn something from every person they talk to every day.
Prozinc/PZI are different, much different from Lantus/Levemir. The Ps do not last as long as the Ls and the Ps also have no shed, making for a less smooth curve as far as I have seen in many cases.
Agree 1000%. The Ps, IMO, are easier to grasp. And then can and do work for 12 hours, and that's all the duration they need on a 12 hour schedule. We don't want overlap if we have a choice in the matter. It makes things more difficult to deal with and understand. The ideal P curve is supposed to look like a smile. As kitty gets better, the smile flattens out. The PS's come down, the dose comes down, the nadir remains safe, in a perfect world. That's our goal. The P's are specifically designed for cats. They are completely different, you are right. And no shed with the Ps. That is why, when a kitty like Ruby who switched to lantus this past week, we advised her bean, Amy to forget the way that Prozinc works, to not "think PZI" when she switched, because they are completely different. Conversely, if someone goes from Ls to Ps, they have to forget everything about how the Ls work or it makes it a lot more difficult to get used to a new differently acting insulin.

Feeding only 2 times a day will create havoc to BG numbers; ask any human diabetic what would happen if they ate only 2times a day.

Very much agree. I fed Bob a small meal at +6 every day that I could fit it into my schedule. Some days that was impossible. Some days it was impossible for me to get any mid-cycle tests. I never bought an auto-feeder or used frozen cubes of food. I did the best I could and checked him and fed him as much as possible without risking losing my job. We just dealt with it as well as we could. And it worked in his case. I am sure that Cathy has the same goals, to test and feed and everything else as much as she can possibly work it into her day to day life. Maybe an auto-feeder, frozen food, middle of the night alarms, whatever it takes that she can manage to fit in. But again, it's only been a month, right? It's probably still somewhat in the "overwhelming" category. We try to advise "one small step at a time".

I don't know how important dose measurement must be for the Ps, but it's pretty important with the Ls, so until you have a constant in place with the dose measuring, it's pretty tough to predict what the numbers may or may not do.
Dose measurement is important with the Ps too. That's why many of the beans use u100 syringes. Using those actually enables P users to be more accurate because of the fact that it's a u40 insulin, and we can make finer adjustments than you can with a u100 insulin in a u100 syringe. Lots of kitties are on mini-doses currently. That's what makes the u100 syringes so important for us. I'm sure Cathy has that on her "wish list" since she's down in the .5 or less dose range.
I never used them because I didn't know I could. But then I never shot a dose that couldn't be measured in .25u increments either. So I just eyeballed them. Had I known it was an option, I would have switched the the u100s right away. I never really asked for dose advice here. Probably because the first time I mentioned dosing and shooting in health, a few people told me I was doing it wrong, without my having asked them what they thought. So I just read and figured it out by myself. Luckily for me and Bob, I was able to do that.

Carl
 
Wow...yeah, overwhelmed would be an understatement...I don't know what I'm doing, my vet won't help, and up to a month ago both my husband and I had a pretty good phobia about needles and blood. Everyone makes me feel like I'm crazy for not just putting the cat down, and my vet and husband thinks i'm crazy for not doing what the vet says. So yeah, thanks Carl!

Anyways, no worries about shots today, she's up this morning. I'll try to get an auto feeder today, I see multiple small feedings come highly recommended.

Cathy
 
Morning Cathy. Yes, someone once described this sugar dance as a steep learning curve at first. I think it is more like a roller coaster. :mrgreen:

People generally start a new thread each morning with the date and the day's news and numbers. You can paste a link to this thread if you like. Will be watching for your update.
 
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