Skinny's yo-yo

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tsteinbarth

tsteinbarth

Member Since 2014
Per Shelly's request, I'm starting a new post . . . In answer to Darrin's post below

I noticed on your spread sheet that on 9/8's pm cycle you gave shot at 8pm, then on 9/9 am cycle gave dose at 6:35. When a shot is given more then +/- 15min per cycle or +/- 30 min in a 24hr period, the + will act as a decrease in dose, and the - will act as an increase in dose.
I am wondering if that had anything to do with this AM's #.
A bounce will come from that 31, so if you see an extremely high number at tonights pmps or tomorrow's amps, know that a bounce can affect BG #'s for 3 days(6 cycles)
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The time differences are related to my schedule and the inability I have to be able to give him the shot at the exact time (or with 30 min) at night. The morning is a little easier. I work 4-10 hr days and often times after my work day ends at 6 or 7 pm, I either am either teaching til 8 or 9 pm or have clients at my private practice (I am a psychotherapist).

I didn't see Shelly's post before I went to work but I am going to go home on my lunch hour today and check his numbers. There were no signs of hypo but I know that really doesn't mean too much.

Thanks for the feedback.
 
Amy, in response to your question

Toni - you may have mentioned this before, I but I can't remember....what type of meter are you using? It will help us to know if you are using a human meter or an Alphatrak.
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I am using a One touch ultra. . .
 
i'm running out the door to work, but saw amy's message about Skinny's 31. That is extremely dangerous territory. Is there any way someone could check on him today? Usually anything below 50 requires carbs + another check in 20-30 minutes. He could be still on his way down from there - we don't know if he's going down or up.

If you have any way to check on him, please do. Carb him up if you can't stay with him, but if there's any way to keep monitoring him to get him over 50 and safely staying there, please try.

You definitely need to reduce tonight. I'm thinking with the long hours he's alone, a 0.5u reduction might be good. Let's see what others think.

from the TR Prtocol:
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.
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Julie:

I did his numbers at +4 his number is @ 211. . . I have not given him anything else.

I don't know what to think of his numbers. It seems he is still "bouncing"?
 
Phew....I am very relieved to see that +4!

Kitties can bounce for a very long time - and some never stop bouncing. I'm not at all surprised to see Skinny bounce from that 31...numbers that low send the body into a panic and it does it's best to compensate for the hypo.

Are you able to post before you shoot this evening? I agree with Julie...at least a .5U reduction is a good idea, even though that is not the norm for TR. Given your work situation, it's a matter of keeping Skinny safe...you don't want to mess around with a dose that will bring him down as low as 31 (or lower) in the middle of the day while you're gone.
 
So glad you were able to test Skinny at lunch.

I'm thinking about the dose that the vet initially started Skinny on. How much does Skinny weigh? Is he at his ideal weight? We often use a formula for calculating a kitty's starting dose, and I don't know that I ever asked you how much Skinny weighs.
 
I'm thinking about the dose that the vet initially started Skinny on. How much does Skinny weigh? Is he at his ideal weight? We often use a formula for calculating a kitty's starting dose, and I don't know that I ever asked you how much Skinny weighs.
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Skinny is probably underweight. I can't recall exactly but around or under 10 lbs. His twin brother is named "fatty". . . and not diabetic . . . go figure :smile:
 
The calculator for starting dose is at the bottom of the Tight Regulation Protocol sticky. If Skinny weighs 10 lbs, that's 4.5kg, and at 0.25u/kg, that would be a starting dose of 1.125u. We would've had him start at 1.0u.

Yes, he's bounced hard. The good thing is that the liver is what keeps a cat alive if they would otherwise hypo, so in this case, his liver's response was appropriate and a very good thing. i'm glad he's out of danger for now.

We need to get him to a dose that you can safely give twice a day. He definitely must have a reduction before you shoot him tonight. I'm not sure what time that is, but if you see this would you let us know, and would you also check back here before you shoot, please?

I think i'd suggest that he go to 1.0u, since he was started at too high of a dose instead of working up to the 2.0u. it's not unusual at all for a cat to need 2.0u, but if he really weighs 10lbs, starting at 2.0u was probably too much. These extremely low numbers that are causing a need to skip shots are scary.

Let's see what others think about his dose. I'd lean towards restarting at 1.0u tonight and seeing if you can give it safely twice a day to him for a while.

Great job checking him today, toni - our first priority is to help you to keep him safe. That can be tough to do when you work. By the way, do you have a timed feeder? Here is a recent discussion on a couple of brands.
 
our timed feeder saved my sanity, and probably punkin's life, when i had to go back to work while he was still diabetic. they are worth their weight in gold, in my opinion.

i hope some others will weigh in about his dose before you have to shoot. 6pm in which time zone?
 
497

I'm feeding him now. He seems ok except a little cranky. . .Unless someone says otherwise, my plan is to give him 1.25 after he eats.
 
so . . . the 497 is entirely expected. his body's reacted to last night's numbers in a big way.

i think i would NOT give more than 1.0u. these numbers will come down when his body clears out the hormones and stored sugars that are making him high, and when that happens, you don't want him to be overdosed.

Consider your ability to monitor tonight. Even though he's high now, as you know, he's been on a yo-yo and he will once again go low if the dose is too high. but it's your call - i just want to make sure you understand the implications of your choice.
 
Hi Toni,

Skinny is "bouncing" from that really low number last night. That's why you're seeing that 497. Remember - we're basing the dose off of how low the Lantus takes the kitty, not how high the numbers get right before the shot. I know it's hard to see the high numbers, but they'll come back down.

I don't usually offer dosing advice, but I agree with Julie that I would try 1 unit in the morning and 1 unit in the evening.

Shelly
 
I'm home tonight. I can do numbers a couple times before bed. . . This is very nerve-racking.

Ideally, he would have food and shot 12 hrs apart. . . if one of those had to be compromised which is it? The automatic feeder will only solve part of what the occasional problem is and this upcoming weekend is one of those occasions.
 
i'm not sure what you mean - can you give a more specific example of the schedule this weekend and maybe we can brainstorm some ideas.

it's always nerve-wracking the first few times you see low numbers. It gets more routine after a while. Part of the craziness with Skinny is that his dose has been too high to give a shot consistently, so his numbers are all over the place. when the dose is closer to correct, often cats will flatten out and it's not so insane.

have you thought about what your goal is for Skinny? The remission rates for diabetic cats that get tightly regulated asap is very high - as much as 90%, according to the latest research. Becoming diet-controlled is the goal for most people, but not everyone. What are you hoping for with Skinny?
 
this weekend I have multiple events taking place, some simultaneously . . .

Friday - AM is fine; PM is going to be problematic as I have clients until 4 pm and have to teach at 6 pm-10 pm
Saturday - AM is a problem as I have to be at a fundraising event by 6 am; teaching 12 pm until 3 pm and headed to Niagara Falls to spend the night for the weekend. It's close to home but PM is a problem as the event I am going to in Niagara Falls starts at 5 pm
Sunday - NOT HOME ALL DAY. and staying overnight in hotel
Monday - home around 10 am. . .

My son will be able to feed him and hoping to show him to how check BGL but he is 22 yo and doesn't live with me so I can't guarantee he will be be diligent with the timing of things.

My goal is remission. Feeding him canned wet food has been an easy transition.
 
ok - the good news is that

1. Skinny is very responsive to the insulin.

2. There is no thought that he might have a high dose condition - not that you were thinking that, but it's something that we see (my punkin had) that makes it harder/impossible to get into remission.

3. you have a son who can be drafted. i say that because i too have a young adult son - now 25, who at 22 took care of punkin for us the summer after he graduated from college and we went to california for several days on a car trip.

here's what i would do, if i were you.

1. draft son immediately and have him learn to test.

2. for this weekend, i'm thinking you might be able to go with 12-18 hour cycles. Sometimes we suggest that to people, just to have some insulin going in, but if a cat's going to be unmonitored, we suggest reducing the dose to the point we can feel pretty confident that the cat won't go low. We can just call this a vacation for you and work the dose accordingly. The best time to suggest a vacation dose is going to be on Thursday. Let's look at him again tomorrow and reduce the dose enough and come up with a schedule to keep him safe and let you go off and enjoy yourself without worrying too much. Then if son can check - all the better. if not, skinny will be safe.

Off hand, I'm thinking something like this:
Friday am - shoot reduced dose. Friday pm, shoot 10pm
Saturday - could you shoot just after you teach?
Sunday - sounds like there's no option except to skip, unless son can learn to shoot as well.
Monday - shoot asap

there's a first run at it - maybe someone else has another idea.
 
I agree with Julie...no more than 1.00U tonight. Lantus dosing is based on the lowest number in the cycle (the nadir), not the preshot numbers. We've seen how Skinny works the insulin, and that 31 was just too scary. Believe it or not, yes - it IS possible from him to drop from that 497 all the way down to the 40s in the span of 12 hours (or less).
 
Julie and Amy:

This has been awesome feedback. Especially the very exact feedback on how to handle the upcoming weekend! I'm hoping to be able to show the "child" tomorrow. . . He's good about filing the syringes and doses just have to get him to do the extra step.

I am very curious to see how Skinny's body responds tomorrow morning.
 
Are we still bouncing???

Gave Skinny a tiny amount of dry food with his dinner and will check his numbers before I give him insulin. I feel like it is important to try and give him something so that he still on the every 12 hr insulin schedule.
 
no, that's not a bounce.

i should add that even if you get a +1 and 2, you'll still likely need to check him throughout this pm cycle to see how low he goes and catch him if he needs carbs.
 
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