Shaikha 5/27 new t.i.d. dosing + curves

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wombat88

wombat88

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Shaikha starts t.i.d. dosing of insulin today. She was up to 529 last night, and at +8.5 this AM was up to 447 already. We gave her a slightly lower insulin dose last night given how unpredictable her numbers were yesterday, but obviously the insulin dose didn't last long given her numbers this AM. The plan is 1 unit every 8 hours. Will see how it goes. My vet wants me to do frequent testing today to try to nail down the nadirs so we can tweak dosing if needed. He doesn't want to start too high as we aren't sure what the cumulative effect will be of the more frequent doses. Am hoping for good things, though I know it will take time. ~O)

AMPS = morning pre-shot, MDPS = mid-day pre-shot, PMPS = late PM pre-shot

5/26 PMPS = 529, gave 1.4U
+8.5 = 443
5/27 numbers:
AMPS = 428, gave 1U
+2 = 255
+4 = 81
+5 = 75
+6.5 = 114
MDPS= 179, gave 0.4U
+2 = 240
+3 = 166
+4 = 139 (fed after)
+5.5 = 197
+7 = 273
PMPS = 252, gave 0.7U
 
judy and squamee(GA) said:
Hope this works. How are you going to do the mid day dose?
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My vet said we'd try to split the daily dose into three pieces, so the plan is to give 1 unit after a mini-meal. But, he also said we'd adjust the dose down if she was still lower than expected by the time of the next dose. I'm to call him if she hasn't reached nadir by the time of the next dose and we'll decide what to do. She's been so erratic some of this will be trial and error.
 
I was wondering the same thing, but I didn't see a drop like this just a few days ago. It is bizarre. The only change is me being home, which may mean she's less stressed I suppose. She also was on zeniquin until a few days ago. Diet has been mostly the same, but today I tried feeding a food with 24% carbs vs. 37% carbs, and she also didn't eat very much of it. That could also account for some of the difference. I'm probably going to have to go back to the higher carb food though because she really didn't eat a lot this AM. Enough to cover the insulin I think, but that could also account for her going lower than expected this AM. I do plan to test hourly until the next shot and discuss with my vet to decide on a dose. He also worried a little about using 1 unit and preferred erring on giving less insulin than much as she's been so erratic in terms of how long insulin lasts and when nadirs are. Wish I hadn't fed the different food this AM but that will be corrected with her mid-day meal as I doubt she'll touch the other. I had to hand feed at the end to get enough in her and she wasn't happy.
 
I think feeding her the lower carb food was fine, if it brings her bg's down a bit great, every little bit helps so if she will eat it I say let her.

If she's just cleared up an infection that could explain the lower numbers too, an infection can raise their bg's quite a bit.
 
Rob & Harley said:
If she's just cleared up an infection that could explain the lower numbers too, an infection can raise their bg's quite a bit.
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I'm wondering about the infection too. She was on several different antibiotics while I was gone because of her last flareup of pancreatitis and a suspected UTI. She's tough to figure out that way because her white cell counts are so low to begin with that they only go into normal range at best even if she has a fever. She had a seriously high fever back in February, for example, but several white cell types barely budged into normal range, while the rest were low, but higher than they had been in that range. So, we usually infer an infection based on a rise in white counts into ranges most people wouldn't blink at or if we see junk in her urine, which happens frequently when her sugar is really off.

Her BG is on the way back up so we'll see how high it goes by the time the next shot is due. Will talk to the vet before I give anything though so we can plan dosing.
 
Wendy, I just looked up from my work and look at those numbers! I agree the infection plays a big part of #'s and you being gone .... actually everything does :) What we are trying to find out is how she responds to her insulin. With as low as she can go, I'm surprised you were able to give her more than 1u without a hypo.

It will be interesting to see what the whole day brings, it looks as if she peaks early, which is what Payne does. Even when we changed to Lantus she had an early nadir ..... IF that is true, then more frequent dosing should level her out. Fingers crossed!

Nancy and Payne
(who has gotten the 100 lb. puppy tuckered out and now they are both in the sun :)
 
Nancy and Payne said:
Wendy, I just looked up from my work and look at those numbers! I agree the infection plays a big part of #'s and you being gone .... actually everything does :) What we are trying to find out is how she responds to her insulin. With as low as she can go, I'm surprised you were able to give her more than 1u without a hypo. It will be interesting to see what the whole day brings, it looks as if she peaks early, which is what Payne does. Even when we changed to Lantus she had an early nadir ..... IF that is true, then more frequent dosing should level her out. Fingers crossed!
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I've not had her ever get that low, but then again we've also lucked out with ketones too. She was at 179 just before when I should give her the next feeding. I fed her but my vet still hasn't returned my call due to a busy clinic today. So, I decided to give her a token dose since the food will make her go higher. I gave her 0.4U, but plan to monitor her closely now given the lower numbers this AM. I know based on her past patterns that once she starts going up, she starts going up quickly. She tends to go high, then low, then zoom up again. Not much in the middle numbers for this girl. I am hoping that if we find the right lower dose of insulin and give it more often that will keep her from doing the zooming we've seen. I do think she can't go a full 12 hours on a dose and my vet agrees based on how she's behaved. She's always had an earlier nadir than what I think is typical for PZI users, so maybe that's the pancreatitis talking.

I did have to switch her back to the higher carb food, because she picked at the other and then left the bowl. She developed a food aversion to the duck after she got really sick in late January, and I don't think we'll be able to get her back onto it. Even when she ate it regularly, she really preferred the dry. I'd start her on a tiny bit of the dry, then try to mostly feed canned, but eventually it got to the point that she ate so little of the canned and was losing weight that I gave up and fed the dry. Then she got sick and wouldn't touch either version again. I've got two cans of rabbit on hand, which I may try if she has a normal stool tomorrow. If not, we'll stick to the HE until the venison comes in. None of these foods are as low as some of the low carb foods I've seen, but after reading tons of labels the problem mostly is the others contain fish or a mix of ingredients that set off her GI tract. So, we'll stick the lowest carb count I can get her to eat in a single protein hypoallergenic food. Hopefully she'll continue to eat it. She's usually willing to experiment for a while on canned, but tires of it quickly. Maybe this time will be different.
 
Wow, great #s today! I'm glad you tried a dose reduction, you just don't know yet what the overlap will bring. Hope the good trend continues! Must be a nice present to get all those blues & greens today, yay!
 
Joanna & Bix (GA) said:
Wow, great #s today! I'm glad you tried a dose reduction, you just don't know yet what the overlap will bring. Hope the good trend continues! Must be a nice present to get all those blues & greens today, yay!
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Yes, it is! I never thought we'd see those. I ended up feeding her after +4 so that threw off her numbers, but she looked so sad because it was dinnertime for her brother and she wasn't getting food too. She actually ate very well, so that was good to see. She only went up a little though since then so we'll see how it is by the next dose time. I'm going to have to figure out how to handle food. My plan was to split up her meals into thirds, but dinner will be tough because her brother will want food as soon as dusk comes and if she can't eat too she'll be upset (or worse, try to steal his food and he eats dry food that does not agree with her). I may have to give a snack at her normal dinnertime as well to avoid having issues, though it will throw off her numbers.
 
Glad to see good movement on the second cycle today too. Now you know that a good TID dose for Shaikha is somewhere between 0.4u and 1u. You might consider 0.6u or 0.8u for your next shot. More than likely the reason you saw better movement this morning is because you were able to create insulin overlap by shooting 4 hours early, not necessarily that the previous dose was too high. The BID dose might have just had too much work to do and it wore off before the next dose was given. Its all speculation anyway. Good thing is that the TID dosing is working!
 
Kelly & Oscar said:
Glad to see good movement on the second cycle today too. Now you know that a good TID dose for Shaikha is somewhere between 0.4u and 1u. You might consider 0.6u or 0.8u for your next shot. More than likely the reason you saw better movement this morning is because you were able to create insulin overlap by shooting 4 hours early, not necessarily that the previous dose was too high. The BID dose might have just had too much work to do and it wore off before the next dose was given. Its all speculation anyway. Good thing is that the TID dosing is working!
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You think like my vet. :) We had a long talk before he closed for the holiday weekend and he told me that he really thought she'd do best in that range, but his bet is on 0.8 units as being the ticket. He also thought the AM period was unusual for her and that she'd level out. I've got his number to call this weekend if I can't figure it out, but he was excited about the changes we've made and thinks it will work out well for her. I hope so too.

How do you handle feeding again? I probably am going to have to settle for a snack at the mid-day dose and at +4 in that cycle to keep her from feeling deprived since her brother eats at that time. She was actually very hungry today. She didn't eat much of the duck, but was far more enthusiastic about the other food I gave so that was good to see. Hopefully her stools tomorrow will be back to being firm. Off to give her a snack and PM shot, then off to bed for me. She'll probably be happy I'm not poking her ears every hour or so tonight, but she'll have to get more frequent readings throughout this weekend until I'm more confident we've got dosing and nadirs down.

Thanks again for all your help!
 
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