no shot under 200 cross post from main forum

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RobbiesMom

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After a day of as much testing as I could get in Robbie seems kind of tired and his breathing isn't good today. Normally I would give him a hit of albuterol but since it is an inhaled steriod and we are just beginning our new fight with diabetes I ma hesitant - he's not really labored but I can see he's getting the "congestion" sound he gets when things aren't great. He's also showed no interest in playing with the dog which is almost always a morning routine.
I realize the 3-4u's I've been giving him goes against most of the input I've gotten here but I am hoping that I'll still get feed back and advice as it is all being used along with my Vets input and my gut feeling to help me down this complicated path with my furboy.
Last night after a day spent mostly in the BLUE he was 369 around shot time (I was about an hour and 15 minutes late getting home) and I gave him 4'us again at +2 he was 320 and I went to sleep. At +7 he was 120 and he ate some, at +9 he was 139 and ate almost a full can, at +11 171 and at what should be shot time he was 179. He is sleeping (not unusual he does need to get in those required 18 hours LOL) but seems a bit more off today than yesterday - or maybe it was just that I was waking him every hour for a test and a piece of chicken and he now he's tired?
I am not giving him insulin and would love to hear any thoughts on where we are - I will cross post this in the PZI forum where I got some very good and insightful advice yesterday.
As always thank you so much for taking your time and giving of your experience.
 
Hi Ellen,
I realize the 3-4u's I've been giving him goes against most of the input I've gotten here but I am hoping that I'll still get feed back and advice as it is all being used along with my Vets input and my gut feeling to help me down this complicated path with my furboy.

You will keep getting feedback no matter what you shoot. You might get tired of hearing the same old thing, :smile: but we aren't just going to kick you to the curb for not following any advice we might give you. Ultimately, it is your call. You are the person holding the needle, and you are the one who has the kitty right there in front of you. The hardest thing (for me) about giving advice, especially on dosing, is that I can have my opinion, and I can tell you what I think, and I could be wrong instead of right. And then you follow my wrong advice, and it's you and your sweet kitty who have to deal with the consequences. That's a pretty big deal to me. What that causes in "us" is one of a couple things. Some people just won't give advice on dosing. Other people will, but will be extremely cautious and opt to "play it safe" to protect you and Robbie (and to protect themselves to some extent). I've given people advice and had it go bad, and there's no worse feeling in the world. It plain sucks. What I personally try to do is put myself in your shoes, and advise as if your kitty were my kitty. I'm probably more agressive with dosing than many other people are, but only when I can look at your spreadsheet and see that a dose has shown to be safe before and nothing has happened recently that would make me feel it won't be safe now.

When I see what I consider high doses early on in the treatment process, it makes me concerned. As I've already demonstrated the past couple days on your threads.

What I think, and what I said yesterday, is that the dose is too high and is causing either curves that are too deep, or cycles that are too long. What I look for is a 12 hour cycle that more or less ends where it starts (BG-wise), with a nadir that is 50%-60% lower than the AMPS and PMPS numbers. To me, that's a good curve for a new kitty on insulin. Gradually, I look for the preshot numbers to come down, and the nadir to maintain that ratio of drop, which usually means the dose needs to come down a bit, or you have to be able to live with lower nadirs.

Looking at Robbie's recent numbers, if all I look at is yesterday's AM cycle, the dose looks "right". Because you got about a 60% drop, the nadir seemed to happen around +6, and he came back up to where he started. I realize that the number you got for the PM reading was higher than the AM number, but it was also an hour and a half "late", and I'm betting he was about 325 at +12. Just looking at the one cycle, every thing looks good. But I can't just look at one cycle and say "all good". You have to look at the whole SS and look for patterns. One cycle is just one cycle, you have to look at trends and see if you see things happening regularly.

When I do that, I see cycles on 4u that run too long. Not sure how low they go in the middle, but the +12's are all too low, which makes it look like the 4u is too much and it's giving him too much duration. When the duration is too long, you get overlap in doses, so even if you shoot less next cycle, the effect is cumulative. The first dose is still "active" when the next dose kicks in a couple hours after you give the shot.
There are a couple of cycles that appear to be good on 3u, but there's not data in the middle to see if they gave you good nadir numbers. They could have been flat, or deep, but if I had to guess, I would guess "flat" because there isn't a bounce evident in the following cycle.
Many people, when they see a flat cycle, assume that the dose isn't high enough and the gut instinct is to raise. I don't believe that to always be true. I think that what can happen is that the cat's body will fight the decrease in BG and the liver will dump "sugar" to raise it. You don't even have to see the "drop" happen on your meter. The liver just does what it is supposed to do, protect the body instinctively. What I believe can happen is that the liver will just keep doing that but one day, it'll just quit doing it. Maybe it does it so often that it just can't do it any more. When that happens, there's nothing to stop the drop, and the dose that appeared to be safe and okay suddenly becomes like a time bomb, and the kitty's system can crash, causing a hypo.

In the past couple of weeks, I and others have "watched" a new kitty go from seemingly okay to clinical hypoglycemic emergency. It was a "higher dose" kitty. Unfortunately that kitty didn't make it. At least 3 other cats have died from hypos in the 9 months I've been on the board. The worst part is that for the most part, hypos are avoidable, even the ones that don't result in ER visits. Some times they just happen out of the blue, nobody sees them coming, and nothing on the spreadsheet would indicate that a dose would cause really low numbers. That happens pretty frequently in fact, as many of the current PZI posters can tell you.

Beyond all of that, specifically with Robbie and today -
You did the absolute right thing posting your number and holding off with shooting on a blue number. Looking at your notes, you fed him 1/2 can when you saw the 120, and another 1/2 can 2 hours later when you got the 139. You would think that would have pushed his numbers up by AMPS this morning, but it didn't really boost him much at all. That tells me the 4u dose was too much. It caused a long cycle again.

So, where are you at now? Have you gotten another test since the AMPS? And has he eaten, and if so, when and how much?

Carl
 
The 4 units scares me also. I would reduce your dose. I have a high dose cat, but I only arrived at that knowledge after months of dosing and working our way up. I just took in a foster cat from DCIN and after EVERYTHING I have seen happen in my year on the board....I started him at .5 units. You can work your way up cautiously and safely. It is your decision, but I would reduce.
 
THANK YOU - I am so grateful for this kind of intense input - seriously it's just too kind. First let me say I hold everyone blameless - you offer advice you are not forcing my hand - I cannot imagine how it would feel to offer advice have it followed and have it go wrong so I totally understand and I've read the guidelines here that you all follow I'm sure and they are well intentioned, thought out and make a hell of a lot of sense. So before anything I have to say to all who are comfortable offering advice that I would never just follow it blindly (unless you were telling me how to help him out of a crash and at that point I did follow blindly and it probably saved his life). I hate to feel at odds with people who are being supportive in any way and are trying to help - if I do not follow exactly what is suggested here it is NOT because I don't think it has merit or comes from a good, knowledgeable place. I am feeling my way along here and it's my journey with Robbie so that's all I'm doing. However, every single thing said here goes into the process and I re-read these posts several times and keep notes as well.
OK so Robbie is OK right now I've been on the phone with my step mother about my dad and have not tested I'm about to do so - Robbie had eaten a few bites throughout the morning but he's been in such a restful deep sleep for the past couple of hours in front of the fire I really didn't want to disturb him and since I was on the phone I let the testing go for a bit. For the record I believe I know what my Vet is looking at when he's advising to stick to 3 or 4 U's - he has the SS from our first time around and he sees 8U's basically jump starting Robbie's Pancreas and after a few days (I think it was 4 but I didn't start self testing or using the SS till a couple of days in) at 8 with I believe (without checking the old SS here) 1 minor hypo scare and one pretty bad one (neither resulted in an ER visit and both were handled with help from here by using some maple syrup and the FF gravy food he adores). They both scared the hell out of me - I dropped him to .50 or 1 and basically gave him doses based on where his numbers were and they ranged from .50 to 1.50 until he was in the blue so often he eventually went OTJ. So perhaps this could happen again? If I can figure out how I'll put a link to that spreadsheet it has a lot more info than the new one and might give anyone kind enough to look more data.
I am going to go test him now and report back - so thank you oh, so very much again. From Robbie and I much "gratitude with catitude"
 
Tested at +2 after no shot and he's 232. He's eaten since 6am this morning about 2.5 cans of FF and several nibbles of chicken as well as a small piece of bacon (his most favorite treat which since his cholesterol is high I guess he won't be getting anymore - after this am). He's very used to an eating schedule that developed after he went OTJ that was basically:
5-6am - half a can FF low carb/calorie
7-8am full can with his metimucil of the same FF
when daddy is home during the day at lunch time which happens quite often he'd get another .5 can of FF
5-6pm full can FF with metimucil again
8-10 .5 of a can generally and than .5 of a can again as I go to bed if I didn't go to bed at 10 - so maybe he'd get a .5 at midnight but this would than generally mean I could sleep in a bit more as he wouldn't bother me at the 5am but closer to 6-7am and since I often work late nights 2 nights a week that has been the pattern. We bought one of those instant feeders with the cold packs and all but can't get the darn thing to work since both hubby and I are pretty good at those sort of things I think we got a lemon one but we are planning on trying again as it could be handy now that we are back on the juice.

Thank you .
 
OK, he's back over 200 which is good, but not drastically high. That's a good amount of food, so some of his number includes food. I think, if the goal is to get back to his normal shot schedule, that you could give him a token dose that will hold him over until then, but not go too long or too low. I'm thinking 1 unit maybe?

I have to go to work, so I might be able to check in this evening, but can't post effectively on my dumbphone. :smile:

Carl
 
Gave Robbie a .50 dose at +3 - hoping to adjust his time frame back to 9/9:30 dose times and probably looking at shooting lower than the 4U's I've been giving him for his PM shot. have to go out for a couple of hours will be checking him again around 8pm - he's eating dinner now.
 
Just got home a short time ago and he's 335 I'd love to give him a dose at 9 or 9:30 and bring him back to that time frame but am truly pondering what to shoot. My leaning is towards 2U's or there abouts. I don't know who might be out there or not at work but I'd love to hear thoughts. If not I'll just be cautious and hope for the best. I don't think there's much of a chance of him crashing at this point with anything under 4.
 
I'm not comfortable offering dosing advice, but here's just a little housekeeping note...

When you have a NO SHOT, you don't "reset" your clock. Instead of +3, it becomes +14 or +16... until you shoot again. Otherwise it can be really confusing (to us) as to when you shot last. But if you gave a token dose, that resets it. You may just want to start a new row on your spreadsheet when that happens - or color code the shot for clarity. Some of us add an additional line for notes throughout the cycle, and others add several rows.
 
Ahhh, thank you Grayson - I was a tad confused and am having a hard time adjusting to the correct jargon etc. even with the cheat sheet printed out to help.

I waited till I guess it would be +9 (nine hours from his .50) and gave him 2u's. We'll see how he goes he was at 337 and will be eating another meal in an hour. I did not see these posts they must have posted as I was testing his blood and getting the insulin. So while I think I cut it close for you Rob here's praying I didn't screw up. Actuallly following Grayson's advice I the .50 was shot at +15 and than the 2.00 was at +9.
I'm hoping to get a shot into him before 9:30 tomorrow, figuring that he'll need one, so I can get to work on time as that is beginning to be an issue, so he'll have an 10.5 or 11 hour cycle again.
 
Ellen,
Good call on the .5, and again on the 2u nine hours later. Hoping you get a nice AMPS. Just keep in mind, and this gets sort of confusing, but for the AM shot it will be "early" in relation tonight's shot, right?

So, an early shot acts like a dose increase, so when the shots are less than 12 hours apart, you want the AM shot to be slightly reduced from what you would normally give Robbie. What I am hoping is that you see good results from the overall reduction today, and your gut will tell you to stay with a smaller dose tomorrow.

I will check in around 9 in the AM since I have to be up to consume enough coffee to get me to a Dr. appointment before I go to work (when I'm on this shift, 9am is "early" to me!)

Carl
 
thanks Carl - yes, I was figuring if I was at 12 hours I would stick with the 2.00 - now I'm gonna see where he goes. I'm beyond exhausted and as much as I'd like to stay up and get some more numbers I know he'll have me up at 4/5am as he always does so I'm gonna go to bed. 9am can seem early for alot of us - thanks for your help.
 
Looking to shoot at around 8:30am my time which would be basically +11 as I'm trying to move him over to times that work with my work schedule - thinking maybe 2.5 or there about - he won't be eating as much today as he does on the weekend cause we aren't around for him to pester until we give in - although I will be leaving him food.
 
OK so I shot a full 3 (a tad over 3.00 but not really what I'd call 3.5) as he was at 367 (sorry I left this out, really hassled by work) he won't be eating probably as often with us not home - he tends to sleep more. He'll hopefully get tested at noonish which will be around +4. His amps was at 8:30am @ 11 hours not 12 but I have to get back to a 8:30 schedule or something like that if I can. So leaving for work anxious and with fingers crossed - I do hate this whole part.
 
Hi Ellen
The link to your ss won't work for some reason.
What was his number this morning?
Carl
 
Sorry - really stupid to be asking for input and not give the required information - I fixed my SS link I had updated my signature and messed it up it appears. - He was 367 at time of his shot.
 
I know that yesterday you needed to adjust your schedule and shot the PMPS at +11. How many hours between last night's shot and this morning's shot?

Carl
 
Does anyone do one number in the am and a different in the pm who's this early on? I'm starting to feel that would be good for him - he eats off and on all day (even though I don't really free feed and he generally finishes all his food immediately if he doesn't finish his breakfast he eats it later on etc.) I don't want to start restricting his diet too much as he needs the metimucil to help him poop and he also lost a significant amount of weight last time we went thru this (plus he sits and screams when he's hungry like he's being killed). But if I have to I can modify it. He ate a lot this morning - daddy didn't leave him food at noon so he won't eat again until 4:30 today which will be about +8 from the shot. What I'm thinking is he might do better with a 4.00 in the am and a 3.00 at night? Anyway, still working this thru but I really would like to see how this works. I have to go back and re-read the reasons why 1.00 was advocated by everyone here - I thought I understood it clearly I am a slow learner with all of this.
 
I don't know about how early on in the process it's done, but yes, there are people who dose different amounts day and night based on the spreadsheet showing it makes sense to do so. There is also the option of changing the shot times to a non-standard spacing (not 12 hours apart), because some kitties regularly run longer one cycle than the other. The 3rd option, if you see drastically different AM and PM cycles is to play with feeding times and amounts to try to make the cycles more similar.

The most important part of the food equation is to hold off on feeding in the 2 to 3 hours leading up to the shot, so that the preshot test number is a fasting number, and food-caused BG isn't part of the number.

There are also people who use a sliding scale, dosing different amounts based on the preshot number.

All of these variables are easier to figure out the more data you have, so it is sort of difficult to figure out what to do when just starting out. But I'm sure everyone is open to bouncing ideas around if you want to try something like this.

Carl
 
Ellen -

I think Angela and Henry are on a 14/10 cycle instead of 12/12 which most of the rest of us stick to. After several weeks of following his numbers and getting a lot of input, she adjusted to that.

You, like the rest of us, want our babies fixed NOW, regulated or even OTJ NOW, but the reality is that it takes time. Takes time to find the right dose, time for the kitty to adjust to the insulin, time for us to find the magic timing/quantity/variety of his food, etc, etc.

I would encourage you to stay w/ the lower dose, and as much as possible, stay w/ the 12/12 until you have more history to support a change. Although he's been here before, he's starting over again, like it or not. If you look at others who've come out of remission, it's the same way. Doses are different, response is different. It's a new start.

I'm the last one to speak to following protocol, as I've chosen to shoot early on several occasions, but if you can, it's best not to change up the time more than 30-45 minutes per cycle. Look at Libby's schedule for Hershey. He keeps throwing long cycles and she keeps gradually changing him back. If he would be consistent, she wouldn't have to keep adjusting, but he has little effect from the change, because she does it gradually. That's key. I think I said this before, but when Grayson was marathoning, 24 hr cycles, my vet told me I could shoot the low number. The baseline to shoot for most people here is 200 - mine was 250 at the start. As it approached that, several times I could've shot a reduced dose, but I erred on the side of safety (and sleep, and work schedule). So, there are always gonna be variables we need to factor into our decisions. All we can do is make the best decision, with the info we have, at any particular time. If it works well, great - if no, regroup and make good notes so you don't repeat a mistake.

Good luck,
Lu-Ann
 
Thank you both. Here's what happens - he wakes me between 4:30 am and 5am every morning (and has for years since pre-diabetes the first time around) and wants a "snack". Before I was married and my husband lived with us I often ignored his screams and he'd end up in bed with me eventually licking my face, pawing at me etc. but by than it would be 7am - a much more civilized time to be awake as far as I'm concerned. However my husband works some odd hours -even though he sleeps with ear plugs the 4am caterwalling wakes him and it's a real problem. So I began about 5 years ago popping out of bed and feeding both the cats about a half a can at around 5am which keeps them quiet until 7:30ish and mommy goes back to bed for an hour or more. So now what I do is I test him as soon as I get up before giving him the "snack" so I do have a pre-food base morning number but as I'm not shooting at 4 or 5am he than gets another test and "breakfast" (full can with met.) at around 7:45/8am than I am trying to get to the point where I can give his shot at that point too - right now I'm still shooting at around 8:30-9 as I'm trying to gradually move him from the 11:30/11:30 which got moved to 10/10 and was at 9:30/9:30 and was on it's way to 8:30/8:30 until I screwed up over the weekend. So hopefully this is OK as long as I know what his number is in the AM before he's eaten. I keep looking back at his old SS from the first time around and while I know this is a new start it seem relevant to me how it went than - I wish I knew how to make that available for viewing also - but perhaps it really doesn't matter and it's just me.
Can someone give me the real meaning of "a surf" I think I get it but as with all of this right now I think since I'm over 50 this time around my mental capacity has diminished :sad:
thanks
 
Sorry this board tends to have it's own language.

A surf is when they drop down into the blues and greens and stays there for a very long time.
 
Carl
Was 11 hours between last night and this morning's shots - maybe 10 hours and 45 minutes? Sometimes it's hard to keep track and he'll make me follow him around to give him the shot some times or like this morning I couldn't get a reading (kept shaking his head and the blood would fly) so everything is generally within 10-15 minutes of what I say/plan. So I was going for 11 hours and it was about that long.
 
Here's a really basic question. What would anyone out there say my goal should be right now? What kind of numbers would YOU be looking to see - what kind of SS would make you happy? Maybe I'm looking at it all wrong. I'd like to see him mostly in the blue, growing into the yellows as the shot time nears - at this point that would be my thought - but maybe I'm over reaching? Being impractical?
Thoughts?
 
Hello,
Glad to meet you, Ellen. I have not followed all of your posts, but think that you may wish to read the following thread about second remissions, Health forum:
viewtopic.php?f=28&t=66682

Good luck to you. (p.s. Don't know why the link is incomplete as it looks fine in the preview).
 
So I came home to a +8 of 157... not sure where that will land us at PMPS time but he hadn't had food since late morning and wolffed down his dinner - he also managed to get into one of the small garbage cans that I have a large heavy book on and wedged into a corner just so he won't eat the plastic bags and cup tops that get thrown in there and he managed to find a bag with some popcorn type treats still in them and I'm sure he licked up the last of those - thankfully I'm pretty sure my husband and I had licked the bag almost clean or I wouldn't have thrown it out in that room.
He also peed a nice normal size pee and than pooped both with me right there (he normally wants to be alone- which makes testing his pee very hard) so it was a happy evening for those reasons and I'm not unhappy with 157 just leery.
 
+10 number is 197 he's eaten a full can and 4 pieces of chicken (small) as well as a bite of my flounder (small, very small) and he's acting very much like himself. just curled up at my feet for a nap. Going to see where he is - if under 200 no shot again and than gotta wonder about later tonight - do I stay up till 12:30 and give him a 1.00 or a .50 at like +15? I really don't know for sure - I was aiming for his PMPS to be at 8:30 pm tonight (his AMPS was at 8:45ish this morning) but I can go till 9pm and see where he is.
 
9:10 and he's 239 - meant to check him at 9:30 but fell asleep woke up and panicked and thought I'd missed the test time - gonna way till 9:30pm which is PMPS and see where we are.
 
253 at what should be shot time - I waited a bit longer as he ate some more (didn't move it any earlier as I had planned will try to do it a bit earlier tomorrow maybe 9am instead of 9:30 and be late for work again). After studying his numbers and weighing all the factors I gave him 1.50. Going to set an alarm and make sure I test him at +1,2 and 3 if humanly possible.
 
I'm mostly posting at this point so I have a record of how things are going since it seems everyone is pretty busy tonight and not around. After a 253 PMPS I opted for 1.50 shot (was itching to make it a 2.00 but held off) and am trying my darnest to stay awake for a +1,2 and 3. +1 is 288 (huh?) and he seems pretty disconcerted (took a few trys to get a reading the strips kept not working - I hate that) and I know he's going to be looking for more food soon. Really hoping things go down a tad at +2.
 
The +1 lookest realistic to me....I am assuming you fed at preshot and the onset of Prozinc can be in the 2 hour range. So, I am thinking the +1 is due to food and the onset of the insulin has not taken full effect. You should see downward movement by +2 or +3. Truly, I have seen +1s much higher than preshots. Your dose prior has worn off and you are waiting for the new dose to take effect!
 
Thank you was just doing some reading and came across some info on that - I am hoping to stay away for +2 and 3 to see what's up.
 
Hi Ellen,
I didn't see the posts from last night until now. I was on later last night but not for long and missed a lot of posts...

Yesterday's cycle on 3.0 looked really good. I'm surprised because I have been thinking and saying that the doses were too high, but it looks like 3 worked for that cycle anyway. The PM cycle, not so good, huh? Maybe the 1.5 was a bit too little. I'm wondering if 2 or 2.5 would have given better results, but I'm just as confused as you are at this point.

Today, the 4.0 is probably too much, but that red AMPS is not something you wanted to see when you got up. If you consider meter variance it isn't really that much higher than yesterday morning's 367. What I am thinking now is that if you see a number higher than 325 or so, maybe 3.0 is the right dose? If it comes in lower than that, maybe we can try to figure out how much lower the dose needs to be.

I hope things are okay with your Dad, and I am sending your family good thoughts and prayers.

Carl
 
Hi anyone out there
So I am still with my dad - actually just leaving the hospital - I have an hour and a half ride home - husband just tested Robbie and he's 473. Not due for his dose for another hour - but I hate to leave him that high. Thoughts?
 
My husband insisted he was up to it so had him give him 3.00. I'm going to go over all my notes when I get home (on my way now - thankfully my sister is driving and I can post from my ipad) but we DID have to buy him a different "flavor" of FF in the middle of all this - just for a few feedings as the local stores didn't have his normal one. I made sure it was the same carbs/calories but wondering if that's maybe something? He's eating, peeing and pooping like a champ and seems to feel pretty good too (jumped up in bed with me last night which he doesn't do when he feels sick or in pain) - just curious as to what is going to even these numbers out.
 
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