? Otto AMPS 107 +5 55 +5.5 92 dose change?

[Ottoman]

Last post

Otto continues to throw me for a loop! After so much trouble getting him to respond to insulin, we had him on 14.5 and he seemed to be doing well. Libre came off on 1/11. Symptoms controlled, no ketones etc. He went hypo on 1/28 and came up with MC food. Reduced to 14 and he was low at shot time 1/30, so I gave half dose and reduced to 13 at the next shot 1/31. He was borderline this morning so I gave 12.5 units. Then he went low again today!

Planning to reach out to his internal med tomorrow, but does it seem like he needs an even bigger dose reduction for next shot?

 

[JoM]

Its so hard to know what to do or whats causing it. I had something similar happen with Karamelle, although shed been on a much lower dose to start. She started going hypo back in Nov last year (plus shed lost some weight), Id lower the dose, shed go hypo again, and on and on, till we got down to 0.1U!! I had no clue what was happening. I decided to do a GI panel and blood work and she had really low B12 and a UTI. Both treated now and she is stabilizing some and back up to 1(Skinny)U. So one of those two things was causing it.
I hope you can figure this out for Otto.

 

[Wendy&Neko]

Did you ever get around to the testing for acromegaly and IAA (insulin auto bodies)? The answer to those questions will help us figure out what is happening. And give better suggestion on how to handle low numbers and dosing.

Did you shoot last night? The spreadsheet shows a blank in the units column. Please put in either NS (nor shot) or skip if you deliberately skip, so we know it wasn't just an error in entry. Whether or not you shot also makes a difference in how much the depot is influencing todays numbers and if he needs and even larger reduction. While you are at it, put that +5.5 number in the spreadsheet too, so we know you kept testing and he was coming up. I would test again in another hour to make sure he stays up.

Over a total dose of 10-19 units per shot, I would reduce by a full unit, not a 0.5 unit reduction. Save the 0.5 unit changes for doses in the 5-9.5 range.

I noticed that on the PM of Jan 30 you shot with a preshot of 61. When using the AT, do not shoot with a preshot of below 68 if you are following Tight Regulation for Dosing, that is too low. If following Start Low Go Slow dosing method, don't shoot below 90. You can always wait 1/2 hour without feeding and see if he comes up above 68/90 before shooting. Or skip if he doesn't come up.

Something is definitely happening with Otto. At a minimum, probably getting over some glucose toxicity - which is where they get used to higher numbers. Dose needs can tumble for a bit when that happens.

 

[Ottoman]

Did you ever get around to the testing for acromegaly and IAA (insulin auto bodies)? The answer to those questions will help us figure out what is happening. And give better suggestion on how to handle low numbers and dosing.

Did you shoot last night? The spreadsheet shows a blank in the units column. Please put in either NS (nor shot) or skip if you deliberately skip, so we know it wasn't just an error in entry. Whether or not you shot also makes a difference in how much the depot is influencing todays numbers and if he needs and even larger reduction. While you are at it, put that +5.5 number in the spreadsheet too, so we know you kept testing and he was coming up. I would test again in another hour to make sure he stays up.

Over a total dose of 10-19 units per shot, I would reduce by a full unit, not a 0.5 unit reduction. Save the 0.5 unit changes for doses in the 5-9.5 range.

I noticed that on the PM of Jan 30 you shot with a preshot of 61. When using the AT, do not shoot with a preshot of below 68 if you are following Tight Regulation for Dosing, that is too low. If following Start Low Go Slow dosing method, don't shoot below 90. You can always wait 1/2 hour without feeding and see if he comes up above 68/90 before shooting. Or skip if he doesn't come up.

Something is definitely happening with Otto. At a minimum, probably getting over some glucose toxicity - which is where they get used to higher numbers. Dose needs can tumble for a bit when that happens.

We haven’t done the testing yet (I honestly was taking more of a palliative approach after his DKA and continuing to respond poorly) but I plan to ask his specialist tomorrow since it seems he’s turned a corner.

The shot last night was an entry error, he got 13 units! I updated spreadsheet with that and the +5.5 from today.

On 1/30 when he was low I stalled, rechecked, and he had come up to 82 or so, so I shot the half dose. Hopefully some more testing can get us an answer. He likes to keep me on my toes!!

 

[Wendy&Neko]

The shot last night was an entry error, he got 13 units! I updated spreadsheet with that and the +5.5 from today.

OK, that might have explained the 55 today, but I'd still drop to 12 tonight.

On 1/30 when he was low I stalled, rechecked, and he had come up to 82 or so, so I shot the half dose.

If you stalled, you can put both numbers in the spreadsheet. Put the 82 in the actual PMPS column. If it was, for example, a half hour late, you'd write 82@12.5. Then you can put the 61 in the +11 cell and write it as 61@+12.

If you do get the IGF-1 and IAA tests done, there are treatments for acromegaly, one of them a daily medication that is fairly inexpensive and does improve quality of life. We've even had about half a dozen cats go off of insulin on it.