Sam - 1//4 +10 397

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KristenP&Sam

KristenP&Sam

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Sam had a hypo incident today (thread here: viewtopic.php?f=24&t=33579) so I'm posting his +10 to get some early feedback on what to shoot tonight. I'm sure the 397 is in part due to the honey and other food he had early to bring his numbers up. I can only imagine his PMPS will be even higher, but I want to give him a dose based on his history, not a reaction. His last two shots have been 1.8 down from 2 units. Thoughts?
 
One more question - I shot his AM shot an hour later than usual because of his low bg. Should I shoot his PM shot at the regular time or also an hour later? I'm concerned if I wait that long, his bg will be really high.
 
Pzi is flexible so it shouldn't be a problem to go back to your normal time tonight as long as his number is shootable. Also, judging from his numbers today he has earned a dose decrease. I'm not sure how much you should lower it though. Hopefully someone else with more experience will be along soon!
 
Lower than 1.8 you mean? So like 1.6 or less? Anyone want to chime in? I'll post his +11 in half an hour, but if it's gone higher, I'm definitely going to shoot then and get him back on his usual timing.
 
You did really great today, Kristen! I know how scary it was.

I'm hoping you get folks replying with what to shoot tonight. Try to hold off on his shot until you get opinion(s)
 
I would shoot lower than what you did this morning. Especially since we're probably not seeing a true bg in him yet. He got lots of extra food and sweets today to bump up his numbers, and his liver probably ended up panicking a bit and dumping some glucose to make up for going so low. That'll clear on it's own, you don't need to account for it in your dose. Ughhh...I don't know how much though. 1.4, 1.5? I don't know how low he wouldve gone if not for the hc food and honey you gave him and I'd hate for you to shoot too much and be up worrying about him all night.
 
I think regardless of what I shoot, I'm not going to sleep well. Maybe lower is better than higher? 1.4 vs 1.8?
 
I know I am more conservative than you, and my experience with PZI is a couple years old. Joan and Bix suggested 1.6 yesterday when you got a 43 at nadir. that was with a higher amps shot. I am afraid if you shoot higher than 1 unit and a smudge, you may be up all night. (Do you have the 100 syringes or do you have to eyeball it?)

This is tough because you have the DKA and ketones history, but you also have a kitty who is going pretty low before and at nadir. I fall back on "better too high for a day than too low for a minute".
 
I know I'm new, but I agree with Sue, for what it's worth. 1.0u. I've been debating suggesting 0.75
 
I do have the u100's so I can shoot pretty accurately. I'm not fighting you on the 1 unit, but isn't going from 1.8 to 1 a drastic change? I thought I read that a big decrease like that could also have bad effects. What do you think? I value your input and experience, so believe me, I'm listening. Off to do Sam's bg, will report back with the number. Okay, he's at 452 now.
 
Well, my thought was 1.8 was too high this am. So what do you wish you had shot? that is the number I would shoot now. The trouble is that 452 is a high number and we have to guess how much of that number is a bounce from 38, and how much is syrup, high carb and whipping cream. It is not a precise science, as you know!

My idea is better safe than sorry, but I know I tend to be conservative.

How much time do you have? We could try sending pms to Joanne and Bix and Gator. My computer tells me when a pm arrives on the board. Maybe theirs does.
 
I wish I'd shot 1.6 this morning, but tonight I'm thinking 1.4 or lower. I would certainly appreciate any other offered opinions before I shoot tonight. I can wait a little longer. I'll pm gator.
 
This is one instance/cycle were you do not want to "shoot the numbers" because the high can be from all sorts of things from today.

I would normally be very cautious but in Sam's case with the keytones I would not want to drop back too much hopefully. Also it is night and I would want you to try to get some sleep after a rough day. I think you are going to need to shoot something in the 1-1.2 range - that's just my knee jerk reaction that's based on intuition and set of the pants rather than anything hard. Half of 1.8 would be .9. 1.2 would be 2/3 of 1.8. I like the idea of the 1/2-2/3 dose.

I know in my advice I'm often a little "number-y." But honestly the math that I really compute on the "chicken" math. How many doses of chicken and how many doses of bravado am I facing at that cycle. Then look at the last cycle and make adjustments. For instance:
night time = 1 dose of chicken
keytones history = 1 dose of bravado
etc.

We used to joke with Judy about how thick she was wanting her chicken soup. :-D
 
Thanks, Gator. I feel comfortable with 1.2 and if need be, I'll set my alarm and get up to check his +6. Going to shoot now. Thanks to everyone who's helped me through today. Much appreciated.
 
sorry. i left work at 6 and just walked in the door now at 7 and got sue's pm. but i will say i definitely agree with the dose decrease and the amount seems fine to me too :-)

i would suggest that mid-cycle numbers have been lacking for a little bit now and clearly there's something going on here so would it be possible to get in a few spot checks on both am and pm cycles over the next few days or so? makes one wonder if he's been going low for a while now and then the higher pre-shots are actually bounces from the large drops?
 
I haven't been doing +6's because my vet wanted me to give Sam a break, but I'm done with that advice now. I will be doing nadirs from now on, that's for sure.
 
I also encourage you to test more than just "nadirs" while you are figuring things out. Their "nadir" will move around too - so +6 is not always going to be the low for the day. Frequently, by the time they are at nadir you have lost the opportunity to "steer the numbers." This is why I suggest testing at +3 which can be a good indicator of where things are headed that cycle. If they are too low/too sharp then you know you will ant to test more that cycle. And if they are headed lower you can start taking less drastic action at about 60 or less. We often recommend feeding a little "medium carb" [maybe 12-16% carbs as %Kcal??] food if you want to soften the landing as it were. Then you can help reduce any of the highs they may get at the end of the cycle from feeding karo/sugar. And if they don't respond well to the medium carb food then you know you will probably want to bring out the high carb food if they continue to drop and get to about 40. It will take a little learning to get the hang of when you should be worried and when you shouldn't be. And hopefully we can try to help you keep thing out of the ranges were you have to intervene.

Some here test only/primarily pre-shots but that's usually after they have gathered a lot of data and are feeling confident about things. I know I did not test much during the mid-cycles, but H was pretty easy to regulate and his dose was almost always less than 1u. Following my example right now for you guys is not recommended. :)

These two links from the PZI Sticky Links might be helpful/appropriate reading currently:

Also I'm not sure if I mentioned it before but do add pressure with a couple cotton balls after testing for about 15-30 seconds. This will help prevent/reduce bruising and callusing [callusing if you really test a lot].
 
Wow, big day today!!!! I am just getting caught up, looks like you did an awesome job getting through a scary cycle! I agree with the dose pick for tonight. I'd probably stick with the same dose for a couple more cycles just to see where you are (barring more unexpected lows of course!). If nadirs are above maybe 150 tomorrow and PSs on the higher side I'd go up by 0.2u pretty quickly. The #s may come down some more tomorrow of course, so hopefully some peeps will be around in the morning & during the day to help you figure out what the #s mean if needed. (I'm back at work this week, so only checking in after 6pm West Coast, if I even manage that.)

Although it was scary, I think this morning's PS was a REALLY good sign. It suggests to me that you've been seeing some rebound from the steep drops and/or lowish nadirs, and by reducing the dose last night, you got better results on the PS. That's EXACTLY what you want to see when you reduce the dose for the reasons you did. One for the textbooks! :-D

This thread reminded me we often used to tell people to post on Health if they have an emergency and especially if there doesn't seem to be anyone around here. If that isn't in our Sticky already, I think we should add it near the top!
 
Joanna & Bix said:
This thread reminded me we often used to tell people to post on Health if they have an emergency and especially if there doesn't seem to be anyone around here. If that isn't in our Sticky already, I think we should add it near the top!
Click to expand...
Second PP of Newbie Checklist [at or near the top]:
Even if you haven't mastered a specific item, please read the entire checklist, and tackle those items that you can. Post in the PZI or Health forums with any difficulties you are having. Someone here has almost certainly been through the same struggle, and can offer tips & support. You can always try PMing ["Private Message"] others who have posted in the past too for ideas, clarification or to point to your topic. If you have an emergency you may also want to post in the Health forum as it can often be more frequently traveled.
Click to expand...
Suggestions welcome. Maybe underline "If you have an emergency?"

Also, I think the "emergency responders" today did an awesome job! :smile:
 
I think everyone did a great job today too. I would have been back at the vets without you all, I'm sure.

I just did Sam's +2 (after the 1.2 pm shot) and he's at 377. I'm going to set my alarm so I can do a +6. Will check in in the AM, hopefully with great numbers.

Gator, I read through those links and maybe it's because I'm tired, but I only understood about half of what was being said. Still, I feel like I have a better handle on what's going on with every day that passes.

And now, off for a few hours of sleep...
 
Yeah Gator, I like the underline idea! I peeked at the sticky (very impressive overall!!!) but didn't read carefully. :oops:

And yes, awesome job helping her today everyone, YAY! Warms the heart. :YMHUG:

Personally I wouldn't worry too much about getting a +6 tonight. The numbers will be all wonked out from the HC, and possible rebound. Of course though I haven't been following closely, so if that's what today's advisors suggested, then go for it! Otherwise, I'd get the snoozing in, you've both had a long day. The +2 is high enough I doubt there's much to fear for low #s this cycle. I'd be more interested to see the nadir tomorrow or tomorrow night, once the # have settled down.

If you get more PSs under 200 though in the next day or so, you may want to consider reducing the dose a tiny bit more, and then get a nadir on that cycle. If it's not low you can always raise back up to the current dose.
 
Good morning! Hope you got some sleep and Sam's doing well this morning...
You did great yesterday

Let us know what his AMPS is
 
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