Smudge: day 3 at home

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allicatmeow

allicatmeow

Member Since 2023
AMPS is 286. He did not eat for over 2 hours before the test (bowl wad licked clean overnight). Unsure is 4U is the correct dose? Cannot (attempt) another BG til +3 today because I have a dr appt for myself.

I absolutely STRUGGLED to get blood to draw. Over 10 pricks and 6 wasted AT3 strips with Er3 over and over (I cannot afford this at $1/ea). My vet tech friend is coming over tonight for his PMPS to try to help show me what I'm doing wrong. He is also more wiggly because BG bed = chicken treats and he's feeling good. I had to actually rush purrito him while he was bleeding to get the reading (which means I drew too much blood to have it still work after chaos).

JL and Chip said:
If you’re up a bit longer before bed, I might try again to get another BG test. A 300 on an AT3 isn’t terrible. And you really don’t know that yesterday’s 84 was the lowest he went. He stayed relatively high and flat today (often a sign of a bounce), so another test might clue you in as to whether his BG might be more active tonight (i.e., start heading down).

A bounce is like ripples in a pond after you toss in a rock…the waves (just like high BG during a bounce) are a temporary reaction, and you just have to ride it out and wait for things to settle back to normal.

It’s easy to want to evaluate a dose during a bounce and assume the dose is ok or even too low, but that is a mistake. Bounce cycles aren’t your typical day-to-day reality. Remember, dosing is based on the lowest numbers, not the pre-shots or the highs. :)

[edited to add: today’s higher numbers could also be a result of skipping last night’s shot, which I initially forgot. So higher numbers from skipped shot, or bounce, or both … the data you can collect will be very valuable.]
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He was too upset last night to even attempt a +3. :( I feel like a failure.

Tagging for insulin dose advice:
@Sienne and Gabby (GA)
@Diane Tyler's Mom
@Suzanne & Darcy
@Hendrick Cuddleclaw
@JL and Chip

Continuation of thread: https://felinediabetes.com/FDMB/threads/smudge-is-home-how-to-start-tr.280987/#post-3099194
 
Suzanne & Darcy said:
Can you leave food out for him while you’re gone? You say you will be back by +3?
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Yes I can leave food out no problem, I will be back @+2.75 for +3 test. He's eating his morning meal now. I need to do insulin in about 10 mins though and not sure if I should drop it to 3.5?
 
allicatmeow said:
Yes I can leave food out no problem, I will be back @+2.75 for +3 test. He's eating his morning meal now. I need to do insulin in about 10 mins though and not sure if I should drop it to 3.5?
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Well dropping the dose to 3.5 won’t help much because he already has the depot of insulin to help carry him along. If he’s eating well this morning and you can leave him with food, you can shoot his regular dose and get back home and test him as soon as you get back. What is he eating?
 
Suzanne & Darcy said:
Well dropping the dose to 3.5 won’t help much because he already has the depot of insulin to help carry him along. If he’s eating well this morning and you can leave him with food, you can shoot his regular dose and get back home and test him as soon as you get back. What is he eating?
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I guess I don't really understand this like I thought I did. I thought the goal is to reduce his dose when we see numbers lowering?

He eats Purina DM wet.
 
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Remember, that the insulin dose is not based upon the preshot number, particularly when you are using a Depo insulin like Lantus/glargine. The doses are based upon the nadir. If he hasn’t dropped below 90, since you are new and following SLGS by default for the moment, then he hasn’t earned a reduction.
 
Suzanne & Darcy said:
Remember, that the insulin dose is not based upon the preshot number, particularly when you are using a Depo insulin like Lantus/glargine. The doses are based upon the nadir. If he hasn’t dropped below 90, since you are new and following SLGS by default for the moment, then he hasn’t earned a reduction.
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Thank you. This makes sense now. I am so frazzled, I didn't even think how I'm doing SLGS by default right now. :(
 
And I would not criticize you if you decided to shoot 3.5 units. It’s scary at first and when we don’t have enough data yet. I’m a little nervous too. But if you can test by +3 you will be able to take care of any low numbers if it looks like he’s dropped more than you want him too by +3. Just don’t forget to leave the food down when you go.
 
Suzanne & Darcy said:
And, since the insulin won’t onset (kick in) until about 2 hours from his shot, you are actually shooting the number where he will be in two hours.
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This was difficult for me to wrap my head around but when it clicked it really helped.

To extrapolate on this more, his BG right now is not food-influenced be as long as he hasn't eaten anything in the past 2 hours. As he is eating well, Suzanne is saying go ahead and give him the regular does of insulin because that food will raise his BG and offset the impact of the insulin as the insulin begins to act, which typically takes about 1-2 hours. Especially if you leave food out. Sounds like you got this immediately and didn't need this explanation, but let me tell you I sure did when I was new haha!
 
Suzanne & Darcy said:
And I would not criticize you if you decided to shoot 3.5 units. It’s scary at first and when we don’t have enough data yet. I’m a little nervous too. But if you can test by +3 you will be able to take care of any low numbers if it looks like he’s dropped more than you want him too by +3. Just don’t forget to leave the food down when you go.
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Food is down and I'm out the door! It really is hard when I don't feel like I have enough data, but what I do know is that he has gotten 4U right along (minus my skipped dose due to 80s) and he has never had a pre shot number under 300 according to my vet or since he's come home. So this is a good thing I would think. A tiny win hopefully in the right direction.
 
Hendrick Cuddleclaw said:
This was difficult for me to wrap my head around but when it clicked it really helped.

To extrapolate on this more, his BG right now is not food-influenced be as long as he hasn't eaten anything in the past 2 hours. As he is eating well, Suzanne is saying go ahead and give him the regular does of insulin because that food will raise his BG and offset the impact of the insulin as the insulin begins to act, which typically takes about 1-2 hours. Especially if you leave food out. Sounds like you got this immediately and didn't need this explanation, but let me tell you I sure did when I was new haha!
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I think it honestly took until this situation this morning for me to wrap my head around this. And believe me, I actually prefer being told multiple times here because it just reinforces it for my very new, very nervous brain!!
 
Suzanne & Darcy said:
And I would not criticize you if you decided to shoot 3.5 units. It’s scary at first and when we don’t have enough data yet. I’m a little nervous too. But if you can test by +3 you will be able to take care of any low numbers if it looks like he’s dropped more than you want him too by +3. Just don’t forget to leave the food down when you go.
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His +3 is 69. Help??

He ate all of the food I left and I just gave him his freeze dried chicken treats during his poke. I also just gave him more Purina DM and he's scarfing that up right now.
 
allicatmeow said:
Food is down and I'm out the door! It really is hard when I don't feel like I have enough data, but what I do know is that he has gotten 4U right along (minus my skipped dose due to 80s) and he has never had a pre shot number under 300 according to my vet or since he's come home. So this is a good thing I would think. A tiny win hopefully in the right direction.
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I definitely think the preshot numbers coming down are a good thing.
 
Wait, I forgot you use Alpha Trak pet meter. It IS time for some HC! Test and see where he is. I will be right here and won’t go away
 
68 is the “take action” number (HC food and/or karo syrup) for a pet meter. But I am not going to quibble about one digit. 69 is close enough (unless you find he is going up already on his own with just the DM and treats.) and always feed small amounts loke a teaspoon so he won’t get filled up - you may need to steer his numbers for a while.
 
The 69 is on the AT3, correct?

Suzanne & Darcy said:
Don’t panic. Just feed him. Not high carb. Jist regular food
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@Suzanne & Darcy I can’t stay around so I’m glad you’re here. Being this early in the cycle on such a hefty (and not arrived at methodically) starting dose, are you sure you wouldn’t recommend intervening with some HC to blunt the drop? I’m not a risk taker so I’d err on trying to slow him down now rather than getting into even lower numbers…

I’d test again in 20-30 minutes.

And yes, Smudge definitely earned a dose reduction (how much might be debatable, but save that for later).
 
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Suzanne & Darcy said:
68 is the “take action” number (HC food and/or karo syrup) for a pet meter. But I am not going to quibble about one digit. 69 is close enough (unless you find he is going up already on his own with just the DM and treats.) and always feed small amounts loke a teaspoon so he won’t get filled up - you may need to steer his numbers for a while.
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Testing now, standby. It's a struggle...
 
JL and Chip said:
The 69 is on the AT3, correct?

@Suzanne & Darcy I can’t stay around so I’m glad you’re here. Being this early in the cycle on such a hefty (and not arrived at methodically) starting dose, are you sure you wouldn’t recommend intervening with some HC to blunt the drop? I’m not a risk taker so I’d err on trying to slow him down now rather than getting into even lower numbers…

I’d test again in 20-30 minutes.

And yes, Smudge definitely earned a dose reduction (how much might be debatable, but save that for later).
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Yes. See above
 
If you can, get a test in about 20 min. You want to see that the numbers are stable or heading up.

@JL and Chip - I believe that's what Suzanne is saying.

Alli - if you have to leave, you'll want to leave out a reasonable amount of food. I'd also indulge Smudge with a good portion of HC food now.

Should you need it, this is a helpful post from the sticky notes at the top of the Lantus board on managing low numbers.
 
Suzanne & Darcy said:
68 is the “take action” number (HC food and/or karo syrup) for a pet meter. But I am not going to quibble about one digit. 69 is close enough (unless you find he is going up already on his own with just the DM and treats.) and always feed small amounts loke a teaspoon so he won’t get filled up - you may need to steer his numbers for a while.
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ITS 59
 
Just let me know if you’re successful in getting the honey into him. I will feel better if he has the quick boost of the honey and some HC to bring him up. You already said he was eating HC. Do you know how many carbs are in the HC?
 
allicatmeow said:
15%
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If it’s easier and if he will eat it, you can always add a drop of honey to the spoonful of food to bump up the carbs a bit more. Most of the Fancy Feast Gravy Lovers are quite high in carbs, and most cats like them. Sometimes just some of the gravy is enough to bring the numbers up.
 
Suzanne & Darcy said:
If it’s easier and if he will eat it, you can always add a drop of honey to the spoonful of food to bump up the carbs a bit more. Most of the Fancy Feast Gravy Lovers are quite high in carbs, and most cats like them. Sometimes just some of the gravy is enough to bring the numbers up.
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I let him lick about half of the can's gravy since he isn't eating the salmon and got one drop of honey rubbed on his gums. Think this is okay? He is happy and alert, acting normal.
 
allicatmeow said:
I let him lick about half of the can's gravy since he isn't eating the salmon and got one drop of honey rubbed on his gums. Think this is okay? He is happy and alert, acting normal.
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Yep. I think this is good. You may want to pick up different flavors of the FF Gravy Lovers food for your hypo kit.
 
allicatmeow said:
He only really eats pate, but I will let him lick whatever gravy he wants in these higher carb ones. A few more mins til retest (he's gonna be so mad). Also waiting for vet callback.
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Yes. He’s definitely earned a reduction! I’m glad because I have been uncomfortable with the vet’s recommendation of 4 units. I definitely think he needs a reduction of more than the .25 units, which would be the normal reduction for SLGS, but I just think the starting dose was too high — better to work your way up than down — but there was his DKA to take into consideration so that complicated things and the vet perhaps wanted to be aggressive because of that — but I will be curious about what the vet says.
 
Suzanne & Darcy said:
Yes. He’s definitely earned a reduction! I’m glad because I have been uncomfortable with the vet’s recommendation of 4 units. I definitely think he needs a reduction of more than the .25 units, which would be the normal reduction for SLGS, but I just think the starting dose was too high — better to work your way up than down — but there was his DKA to take into consideration so that complicated things and the vet perhaps wanted to be aggressive because of that — but I will be curious about what the vet says.
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Okay he is up to 109! So crisis averted.

Vet called back, she said lets drop him to 3U so long as his number is hovering around 300 at his PS tests. She said tonight may be wonky because of the honey/HC food and not to panic. If he is more like low 200's then we need to consider 2U and she said to use my best judgement tonight because I did so well in the crisis. I told her it wasn't me, it was you coaching me through and how thankful I am! She said call anytime of course if I am unsure, but said it sounds like I (we) got this, especially because Smudge is happy and eating really well.
 
allicatmeow said:
Okay he is up to 109! So crisis averted.

Vet called back, she said lets drop him to 3U so long as his number is hovering around 300 at his PS tests. She said tonight may be wonky because of the honey/HC food and not to panic. If he is more like low 200's then we need to consider 2U and she said to use my best judgement tonight because I did so well in the crisis. I told her it wasn't me, it was you coaching me through and how thankful I am! She said call anytime of course if I am unsure, but said it sounds like I (we) got this, especially because Smudge is happy and eating really well.
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Okay good. I’m happy with that. Now you need to keep testing to be absolutely sure that Smudge’s BG will not drop back down. Normally we would say to get another test in 30 minutes. I know it’s a struggle for you right now. But I definitely would not recommend going past 1 hour. Several things could happen. He could drop back down in BG when the carbs start to wear off. He could also start to climb. Tonight may be quite high due to a bounce. You can go back to feeding him a teaspoon of LC again and no more HC unless he drops to 68. The rule is to keep testing for two hours after the time that the last HC was given- to ensure that the BG stays up in the safe range.
 
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Why do vets always seem so focused on the pre-shot number far as the dose goes. It's not about that! It's about how LOW the dose takes him when it is hitting hardest.

Regardless, I am happy to hear the vet wants to drop the dose. As Suzanne said, so much better to start a little lower and increase as needed if the numbers tell you so.
 
Suzanne & Darcy said:
Okay good. I’m happy with that. Now you need to keep testing to be absolutely sure that Smidge’s BG will not drop back down. Normally we would say to get another test in 30 minutes. I know it’s a struggle for you right now. But I definitely would not recommend going past 1 hour. Several things could happen. He could drop back down in BG when the carbs start to wear off. He could also start to climb. Tonight may be quite high due to a bounce. You can go back to feeding him a teaspoon of LC again and no more HC unless he drops to 68. The rule is to keep testing for two hours after the time that the last HC was given- to ensure that the BG stays up in the safe range.
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Should I be letting him eat all the way through? Skip the 2 hour fast before +6 nadir?
 
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