Obie amps 73 and I gave his shot 1 hr early by mistake

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Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

+1 hour after early shot he is at 61. I gave him some higher carb food to boost him.
Am I wrong in thinking that it would act like a dose increase earlier and a dose decrease by his next shot time?
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

Shooting early does act like a bit of an increase, yes.

Keep a close eye - do you have lots of test strips on hand? Also, don't over-feed him....you want/need him to be able to eat later if he really needs it.

I need to get my own crew going, and shortly after I have to start getting ready for work, but I'll check in on you as I can.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

I have tons of strips. So far he is still really hungry.
I am going to test him every hour until I am sure he is in a safe place.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

If he starts getting closer to 50, you may want to test every 30 minutes to make sure he's not dropping too low. Do you have karo in case you need to add a few drops to his food?

Keep in mind that his shot time has now changed. His next shot should be 12 hours from the time you shot. You can move it back as you go along in 15 minute increments if you have the flexibility in your schedule.

I won't be on the board much longer, but will check in later.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

I agree with Carla - if he does get closer to 50, you want to step up your testing frequency. As long as he's over 50, you can basically feed him as you normally would; you just don't want to toss a ton of super-rich HC food at him all at once, since that can either fill him up all at once, or possibly cause a scarf-n-barf. If he starts creeping too low, try a little bit of HC gravy. Karo can come in handy, too.

Since you shot an hour early, as opposed to an hour late, adjusting back to your normal shot time may be a little bit easier, but we'll cross that bridge when we get to it.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

I'll do that. And I do have syrup.
I am about to test him again.
he is at 48 on the Relion. I tested him on the alphatrak2 and he was 69
Gave him some high carb with syrup in it food
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

That 48 is at +2? Since it is so early in the cycle and he's dropping despite HC food, you should also be prepared to possibly take Obie to the vet for a glucose drip.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

I will. I am going to test him again in another 20 min.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

he was at 37. Gave him a some nutrical (which is what the vet gave me for him)
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

I think you need to get him to the vet....he's dropping too much even though you're giving him syrup and HC food. Once you hit the 30s like this, it's nothing to fool around with.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

I've caught him as low as 33 before. I am going to see if he is rising any and if he isn't showing signs in the next hour, I will.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

When you caught him at 33, it was at +7, not at +2.5. A hypo situation with Lantus can last up to 16 hours. If he has not come up significantly with the next test, he really needs to be on a drip. Sometimes we cannot manage these things at home.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

ok. I think I should skip his shot later though.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

One step at a time....worry about tonight's shot later on.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

Let's not focus on the next shot. I agree with what everyone's telling you -- if you don't see numbers coming up despite HC and syrup, Obie needs to be seen by a vet.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

the high carb food was ocean whitefish and tuna in gravy by fancy feast. The corn syrup stuff was just given after his last test.
Before I mixed just a small amount with his food. I shot a syringe full of it in his mouth after his last test. I am going to check him again in 6 min
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

he is 33. taking him in
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

I'm glad you were able to catch that 33 and get him to the vet. Sending prayers and hugs. :YMHUG: :YMHUG:
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

Update: When I last tested him he was 29 on human meter.
When I got him to the vet he was at 69 on their meter, an hour later he was 82. He is now at home and the emergency room vet was nice enough to only charge us 38$
She said only shoot him tonight if he is over 200.
He seems to be doing OK now. They were pretty impressed by the monitoring I was doing and the nutrical I gave him. And they also backed up the use of the human meter as being OK. I think I love her! :razz:
Thank you all for your help. Oh, Happy Friday!!
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

I'm glad Obie is back home and coming back up. You may want to keep testing him every hour for a little while to make sure he doesn't drop back down. If you need help on the dose tonight, just post in the subject line when it gets closer to shot time.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

I will. I think I set him up pretty good for a crash today. I should have skipped his shot this morning, let alone give it an hour early.
I am really lucky that he is 8 and pretty healthy. He was a reserve cat for animal testing, so he's tough.
Right now he is pretty pissed at me. Hell, I'm pissed at me.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

Shooting a 73 isn't a bad thing (unless it's a reading on an AlphaTrack). I suspect the combination of shooting low and the early shot was the culprit. It looks like you've been shooting in the 60s so it sure seems like the accidental early shot was a major factor.

I tend to agree with what seems to be a very knowledgable vet at the ER. If Obie is still low at PMPS, skip the shot.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

Excellent news, and excellent work taking care of Obie today!!
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

Thank you. She was a great vet/technician! I wish she had a practice. She could have charged me an arm and a leg and gave him all kinds of different test he probably didn't need and she didn't.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

*whew* glad everything worked out ok, James! and that Amy, Carla and Sienne were available to help you through it.

just to make sure you know that you would reduce his shot tonight by 0.25u after the low numbers today. He may bounce from hitting the 30's. If he's really high you have the option of giving one more shot at 1.25u to "shoot through the bounce" or go right to the 1.0u shot tonight. It's your choice. If you choose to keep one more shot at 1.25u, I'd make sure to monitor extra afterwards. Often cats that are beginning to show a lot of green will either not bounce or will clear bounces very quickly, so i wouldn't assume that if he bounces, he'll stay high for any length of time. You'll just have to test to see what happens.

In fact, a few extra tests later today may be really helpful information for if this happens again. Then you'll have an incident to look back on, with the data from what happened next, to help you in the future.

About the time for shooting tonight, because you are shooting later, you could just make this a 13hr cycle and get yourself back on your usual time. There is more of an impact to the depot when you adjust by more than 30 minutes a day, but in this particular case, maybe you want a little bit more impact on the depot. I agree that it's likely the substantial drop you saw early this morning was from the increased overlapping of the end of the previous cycle with the onset of this cycle.

When you're moving earlier in the cycle and making the cycle less than 12 hrs, the plan Carla gave you is a good one for minimizing impact on the BGs. There are times (not tonight) when increasing the overlap of the two cycles can be really helpful in managing blood sugar, but you'd want to know what you're doing if you ever wanted to do that.
 
Re: ****! Obie amps 73 and I gave his shot 1 hr early by mis

Thank you,Julie. :smile: I will most definitely cut his dose back to 1u.
 
At an hour past pmps Obie was at 98 on Relion!.
No shot tonight, and I'm amazed he is still that low.
He ate a full meal and seems to be back to himself.
Thank you again everyone for talking me through this crisis. <3
 
James, there are 3 options when you're faced with a low preshot. You don't have to entirely skip the shot tonight.

from the Shooting and Handling Low Numbers yellow starred sticky:
HOW TO DEAL WITH LOW PRESHOT NUMBERS

**** The following guidelines apply to the Tight Regulation Protocol for Lantus or Levemir ****


You just tested your cat’s preshot number, and there is a much lower than usual number staring back at you. What do you do?

There is no one-size-fits all answer, but there are some general guidelines. As with everything else, each cat is different (ECID) and each caregiver is different too.

The short answer is that most kitties can be shot at +12, almost regardless of the number, once you are data ready to do so. The exception is that shooting 30s or 40s is not recommended for most cats, so if the cat is less than 50 then usually the best option is to wait until they are above 50 to shoot. While you’re waiting, the shed is draining, so you want to get the insulin in as soon as it makes sense to shoot.

If it is your first time shooting green, then we will likely suggest that you stall the first time, even if the number is 80-100. That will let you collect data on what your cat will do when you stall. One thing you can do if you are having a low cycle is to get a +10 and +11. Those will give you a good idea of how quickly the cat’s numbers are rising (or not) when preshot time arrives.

Beyond the general guidelines, there are other factors we consider when we are helping someone with a low preshot.
If the low preshot is not part of that cat’s normal pattern or there is reason to think something might be wrong, we will be more conservative.
If the cat is not a food spiker or tends to have an early onset/early nadir then they may not want to shoot as low. If the cat has a late nadir, then they will HAVE to learn to shoot low.
We will also be more conservative in some cases because of the person – if you are not able to monitor then you want to be more careful, or if you are not sure that you can get back to the board to keep us updated throughout the cycle. Trust me, if you shoot low, we will be watching for your updates and we will worry if we don’t see them.
We have to be a lot more careful with the cats who eat only dry food, because they don’t have access to the tools the rest of us use to keep our cats safe.
Also, when it comes to very low preshots, there is an unwritten rule that whoever helps that person shoot low should expect to sit with them through any low parts of the cycle. There have been times when I knew a cat’s number was likely shootable, but I also knew that I could not be around to help if the shot resulted in low numbers later in the cycle. For safety’s sake, if I could not find someone else who would be available to support for the next several hours, I would most likely suggest that the shot be reduced or skipped. I will not encourage someone to shoot low and then abandon them.
There are a lot of other scenarios, and you always want to keep your cat in mind.

Some general rules when stalling (ECID):

** 50s or higher – don’t feed. The number will bump up on its own soon due to the insulin wearing off.
** 40s or lower – you have a couple of choices.

When 40’s occur at the end of the cycle, it can be beneficial to withhold food and test in 15-20 minutes to determine if kitty is on the rise or hasn’t reached nadir yet.
If they are hanging in the 40s for a while, or if they are still dropping, it is ok to feed a tsp or two of LC and retest. This is very tricky. You want to avoid feeding too much while you’re waiting for them to go over 50, because you don’t want to artificially inflate the number with food.
--- Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he?

** Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you.

Perhaps the most important guideline in shooting low is that any time you shoot your lowest ever number, you should get a +1 and +2 to give you an idea of how the cycle will go. If the +1 is not higher than PS, or if +2 is much lower than PS, that means “pay attention” over the next few hours. Those tests will also help you become even more data ready for the next time you are presented with a low preshot reading.

Using the overlap by shooting low is a great way to take advantage of Lantus/Levemir’s long, flat cycles, once you have learned to do so safely.

~ written by Libby and Lucy
Click to expand...

I'm not sure if you're following TR or not, but the option that I would think might work well for you if you haven't fed yet, is the one I've highlighted above. That will get some insulin into him and prevent him from being sky-high in the morning. When/if you do shoot, get a +1 and a +2 to see where he's going. Just a thought.
 
Normally I would do that, but he has had such an oddly low few days that I'm kind of curious to see where he might be at in the AM.
Part of me is curious to see if maybe he is trying to go into remission or not. Also, he is really over the ear pokie pokie tonight. He rebelled earlier and even refused to eat.
I was able to get a reading from his ear when i fed him a bit ago, but he was still over it. I'm hoping he forgets how much he hates it by morning.
I know his shed will be half empty by the morning and it will take a few cycles to get him in a good spot again.
I am going to give him his shot(Reduced by .25) in the morning at the usual time unless he is below 100.
It seems for the last few weeks he was doing great during the later part of the cycle and several hours after pmps but usually ends up 300+ on the AMPS.
except the last few mornings where he was below 100. Makes me wonder if his reserves of all the stuff that they release to rebound may be running low, and thats partially why he all of the sudden is showing really nice AM preshot numbers. I don't know. Thank you enough for caring enough to help. :smile:
 
Obie seems to have moved from the "Increasing the Dose" phase in the protocol to "Decreasing the Dose." It may very well be that his pancreas is healing and that's why you're seeing some lower numbers. Personally, I haven't seen a cat go from 1.25u to OTJ in one step. Most typically, cats go down the dosing scale 0.25u at a time, ending at 0.1u before going off of insulin. I think what you're saying is that you're wondering if he's ready to go OJT? Is that right?

We know from past cats that the ones that get into a strong remission are those who have had insulin support as long as possible. Here's the relevant info for you:

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

Please do not let yourself become complacent or blasé about drops into the 20s or 30s.
If kitty drops into the 20s, a full reduction of 0.25u (or 0.5u if kitty is on a higher dose) is strongly recommended.
If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
Please ask for advice.

If anyone suggests otherwise, they are putting your cat at risk! Our kitties are not just numbers. They are living beings who trust us to look out for them. The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive.

Keeping YOUR cat safe is the #1 priority of the FDMB.
Let's keep all our kitties in the Lantus Tight Regulation ISG safe by suggesting and taking appropriate reductions.

If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction.

Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding a dose in-between the dose that dropped kitty too low and the reduced dose.

Since 2006 we've encouraged those practicing Tight Regulation to attempt reducing the dose from 0.25u to 0.1u before stopping insulin completely. During a two week OTJ trial, you want to see mostly green numbers (under 100) with only a few random blue numbers between 100 - 120 to help ensure a strong remission.
Click to expand...
 
I'll just add that what I've seen in most cats, is that first the nadirs go green in each cycle. Then the time spent in green mid-cycles typically stretches out to a few hours.

Next the pmps goes green and the very last is the amps. It's the last because the body puts out hormones in the early hours that raise the amps, called Dawn Phenomenon.

Not every cat follows that particular model. Some bounce all the way to OTJ with pinks in between their greens - some cats take months to inch down the dosing scale by spending a week at a time in normal numbers. Some have reductions coming fast and furious. The main thing is to take the cues from the cat's blood sugar tests and follow their lead. A little while ago i wrote some about shooting low to Darin. It might help explain a bit more of it - the post is here.

It looks like Obie's got the green mid-cycles, and his pmps numbers have been coming down mostly into normal range. His amps is still high. Today's cycle marks a significant difference on his spreadsheet.

Anyway, there's my 2 cents worth of thoughts after looking at his spreadsheet. :mrgreen:

no charge. ;-)
 
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