Simmie AMPS 336 Last night spot chk 296

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LydetteSimmie (Iceman)

LydetteSimmie (Iceman)

Member Since 2014
Hi all,

Simmie has been doing really well - at least from the outside. He plays with my fingers, sits with me all the time, licks his ice, pees and poos, and seems just great. But if you take a look at his ss then you can see it is finally time to up his insulin. I think. No, I know, based on all the knowledge I have learned here and from my previous post.

This is my issue with uping his insulin tonight. We are going on vacation this Thursday and he'll have to be at the vet. I know it will take some time for his little body to adjust to the new dose and I am very nervous because they won't test as often as I like. I am looking for a new vet but haven't been too successful at finding one who appreciates our perspective. So the question is...what is the risk to my beautiful boy if I increase his dose tonight knowing that he'll be going to the vet for a 5 night stay shortly?

Oh, my ss says I am giving him 2.5 dose..it really is about 2.75 but I can't be sure because I don't have the proper syringes to see 1/2 units. Someone recommended a good idea when adding a dollop more of insulin and I have been doing that but I simply can't be 100% sure I am getting the proper dose, OH SIMMIE JUST WOKE UP AND HE HAS HIS HEAD DEEP INTO HIS MINI-ICE BOWL, LICKING HIS ICE! It is way cute. I will get a pic of it for you all at some point but he is shy when licking his ice. :-D

Anyway, any advice would be appreciated.
 
Here's your last condo:Friday

On Friday, Wendy, Marje & I all said to increase on Saturday night or Sunday morning. I wouldn't wait to increase just because you're going to be gone on Thursday. You can reduce his dose while he's at the vet's.

For his safety, though, you really need to get a mid-cycle test (i'd get somewhere in between +3 to +6) every cycle. Without knowing how low he is getting on a dose, it's pretty difficult to know what to tell you about dose increases. The more data there is, the more confident you can be about what he needs.

The day before you leave, post here and ask for a suggestion for a vacation dose. Several people have cats that can't be tested by anyone else (Sienne for one) while they are traveling and just reduce the dose while they are gone.
 
Hi Lydette:

I was boarding Cinco at a vet that didn't test enough, too. I always reduced his dose when he was there, and he did fine. I picked an even amount, like 1.0, that was easy for them to measure. He usually got back on track within a couple of days after we got home. I have a new sitter now, and she has assured me she will follow my instructions to the letter, testing as often as I want, so I am planning to keep his dose the same when we go away for a weekend in a couple of weeks. I know she is a rare jewel, because I looked for someone for months who would do as I asked, and until a vet at UCD recommended her, I had NO luck. At least, if they are not testing often enough, it is a vet's facility, so they can treat Simmie if there is a problem. Better there than a sitter that doesn't test!

Good luck with the dosecrease. I can't wait to see a picture of Simmie and his ice!
 
Hi Julie and Tricia,

I know I asked during my last condo and got good advice. Then I thought about the vacation and knew we would be out most of yesterday so I held off. I did a curve a couple of days ago so I have a bunch of mid-cycle tests.

I just got a BG 214 at +6 and I do think his nadir is either +6 or +7. I only got 4 hours sleep last night so I have been dozing today. Simmie has dozed with me.

I will need to be out of the house tomorrow and Weds, both for many hours when Simmie hits his nadir. I guess that is not the optimum time to change his dose but if it is the right thing to do than I'm game.

I could change his dose for his evening shot tonight but I'm nervous I'll be finally having a decent sleep and won't be able to check mid-cycle.

I do apologize if I sound dense and don't take advice right away. I guess I have so many things that seem to be going on that I second guess myself.

So, only question left is should I shoot the new dose tonight or start tomorrow?

thank you so much,
Lydette

ps - adorable Iceman pics coming soon!
 
I agree that Simmie looks like he needs more juice, too, but I also agree with your apprehension about doing the increase before you leave for vacation, since you'll be leaving in just a few days. I'm not sure how much he would benefit from an increase, only to be decreased again in a couple days.

I know you mentioned your vet won't test as much as you'd like...how reliable do you think they'll be with testing and overall monitoring? How long will Simmie be boarding there? So they have someone on-staff 24/7? Those answer will help us help you figure out a good dose for while he's being boarded.

I'm really looking forward to The IceMan pictures....I love kitty quirks!!
 
if you're not going to be able to monitor him mid-cycle for the next few days before you leave, then i agree with Amy that you should wait til you get back to increase.
 
Oh Amy, thank you so much for your note. It made me feel a little better.

He has to go to the vet this Thursday early afternoon and will be there for 4 nights/5 days, no 24/7 care. As for testing, I had a real challenge with his vet today. She said they don't like to test at all with FD while their there because of the stress component...though in the past, before I found you guys, whenever we went away and boarded them that's when they did the curve. But, I digress. I actually think my subtle way of educating her has really started to help! After our first aggressive confrontation I knew I had to find another way of getting her to understand what is discussed and recommended here...and one of the first things I realized was that I could not 'challenge' her authority but merely suggest ideas and keep her updated and work as a team. This seems to be working really well. Today I mentioned the Roomp and Rand study and mentioned I could bring her a copy, that it was peer-reviewed, and she might find it interesting as it is what is providing me with direction. She said she thought it was a good idea!

Anyway, as mentioned, I started discussing the spot checking and at first she seemed really negative about it, especially when boarding - she didn't see the value. I explained that it made me very uncomfortable if he wasn't tested during the day but her feeling was that because their BG is usually higher when boarded it shouldn't be much of a problem adjusting his insulin to 3 units now. We went back and forth on this discussion and she finally said that if it was important to me to have him checked during the day then I would just have to tell them when. I said I thought that it would be best at his nadir, which was +6 or+7. She said that was fine.

Unfortunately there is no one at the clinic after 8:30 pm, which is concerning to me. The techs are back in at 7:00 am. Also techs are only in the clinic for a few hours during Sundays and when they have to give pre-defined shots (like FD babies). So that leaves our 'kids' with long stretches of being alone. Because Simmie is boarded in the hospital and not their kennel facilities they do keep more of an eye on him during the course of the day, again, except for Sundays.
 
we had a vet tech come to our house, test punkin and give him his shots. i really liked being able to leave him at home, but that was usually just for evenings out. we only actually left him overnight when my son was living here, and he tested him regularly for us.

i think if you're reducing the dose it's probably ok if he's not getting checked as much.

Here's the information for you on increasing the dose. I wouldn't go to 3.0u. According to his blood sugar data, most of his nadirs are in the 200's, so you would increase by 0.25u to a new dose of 2.75u.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

by the way, i'd encourage you to just get a couple of spot checks every cycle instead of thinking in terms of doing a curve. it's more helpful if you sprinkle tests around throughout the 24hrs. Nadirs don't stay fixed in one time. This is what I wrote to someone else about the value of spot checks:

I think of the spreadsheet like a jigsaw puzzle. If you have only the corners and edge pieces, it's pretty hard to see what the picture is. But if you have pieces spread here and there all over the puzzle, it becomes easier to decipher the picture. That's exactly what the spreadsheet is for us. It helps us to see what the Lantus is doing when we can see the past 3 or more days with a sprinkling of tests here and there. Right now you've done a super job of getting tests in - it's giving us edge pieces and a couple of stripes down the middle of the "puzzle." It would really help to see some variety in the test times. Does your schedule allow you to get some different times? Your plan for a +4 and +8 today is super.

I'd suggest one day getting a +2 or +3, then maybe a +5 (since you have a lot of +6's), or +8, and then in the evening cycle get some different times, maybe a +4 or right before you go to bed. Your total per day doesn't necessarily need to be more tests, just vary the times. Does that make sense?
Click to expand...
 
Thank you Julie, I have done more spot checking than curves but not enough regardless. I like your recommendations.

As for going from 2.5 to 2.75 because I do not have syringes that display 1/2 units it's been kind of a crapshoot in even doing the 2.5. When he seemed to be still high I nudged the syringe a bit more, not to the 3 unit marker but added what I call a 'dollop' extra to his 2.5. It seemed so unscientific and since I couldn't really quantify it I kept my ss stating that the dose was 2.5. Does this make sense? I really want all my data to be truly accurate but I didn't know what else to do.

So, I think maybe 3 units is the way to go but I don't have much time to think it through since he's due to be tested and shot in 15 minutes. Because I am so tired tonight (only slept 4 hours last night) I won't be able to test him throughout the evening. Do you think I should wait to increase his dose until tomorrow? I know someone else on this board, who is also wonderful, thought perhaps I should wait to change his dosing until I returned from vacation (vac is from Thurs until next Mon).

OK, so I am going to think for myself a little bit here. I do not think I will increase him until tomorrow. Before I have to leave the house I'll have 6 hours to spot check him.

Hugs to you and everyone for all this help!
 
Just a last note for the evening. Simmie's PMPS number was 369! I have no idea why he is going so high all of a sudden. I guess I wish we weren't going away at this juncture but it can't be helped.

Thanks for all the support today everyone.
 
Amy suggested you wait til you get back from vacation. that's fine too.

As far as fine-dosing - have you looked at the photos on the "new to the group" sticky? they show how to put the plunger to get those tiny doses. that might be helpful. If you really pay attention to where the black plunger line is in relation to the lines on the barrel, you should be able to get consistent fine dosing. some syringes are easier than others - the fatter the barrel, the more difficult it is to adjust by 0.25u increments. I thought the Relions were extra difficult because of the barrel size.

when you need more syringes, you're going to find it easier to dose with ones that mark the 0.5u on the barrel. There are many - i liked these http://www.americandiabeteswholesale.com/product/terumo-thinpro-insulin-syringe_5891.htm. You can buy locally too, although i always got everything from ADW (above.) Many people register with http://www.mrrebates.com and then you get a rebate on everything bought at ADW.
 
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