Snowflake, back from vacation

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equine99

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So, the last 9 days ended up being a total mess :\

The lady who I hired (who came highly referred from a family friend) just doesn't understand how insulin and diabetes basically work, even though I explained it all to her when she came over for the initial meeting. She was really nice and great with the cats, but just didn't "get it".

Basically, Snowflake stayed in the 300-400's, getting 0.4 twice a day for the first 5 days and then upon realizing that she must have been shooting into bounces (once my roommate finally emailed me the numbers), I decided to have her only do it once a day. On the second day of once a day she was 107 at +24 and despite by very clear instructions not to shoot under 200, she got 0.4 because "well it was so low, so and I didn't want to take her off it cold turkey" so clearly she really just doesn't get it. My roommate who was here said she thinks the sitter thought the high numbers were good, and obviously doesn't understand insulin if she shot because she thought it was too low. Oyyyyyyy.

One day that I thought was interesting was:

5/2 8am couldn't get a reading, gave 0.4
5/2 8pm 395, no shot (because I'd said only one shot a day)
5/3 8am 107 (then she stupidly gave 0.4)
5/3 8pm 506 (no shot, must have been an awful drop and bounce/i can't believe this happened)

Could this mean her P kicked in even with very high numbers?

I just got home and at +14 she was 381 and looked shaky so I gave 0.4, and will test at +1 and will then test throughout the day tomorrow. Basically, I feel like I'm starting all over again.

She's clearly lost some weight, probably from all of the ups and downs, too.
 
Glad you're home and can take control of the situation. It's very frustrating to be away, knowing that someone else is caring for your babies. I'm fortunate to have great friends who have experience - and others I feel confident in their abilities to follow directions. That's a huge difference.

Sorry she got so out of whack... give yourself and Snowflake a few days to re-adjust and everything will be good again!
 
Well, glad you're back and hope it was all lovely over there!

Interesting numbers, you running a curve today to see what's going on?

Cathy
 
Aside from all of this happening, my trip was excellent! Not a lot of things could've made it better, and I even got one day of beautiful sunny weather.

I'm definitely going to do a curve today. Just woke up and at +11.5 she was 440. 1/2 of me wants to give do a curve without insulin to see what happens, and the other half wants to give her 0.6 and do a curve of that. I might hold off on the insulin until/if she rises.
 
Wow, what a wild ride Snowflake had.

If she went from almost 400 to 107 in 24 hours without insulin, I think I would go very easy on the insulin now. I wouldn't shoot more than a few drops.

The curve today should help you get back on track with how she is doing.

Welcome home.
 
So I guess my biggest question right now is, should I do a curve without insulin and just see what happens or should I give insulin?
 
Her number is high enough to give insulin but I would only give a token dose. Maybe .2 or .3u at the most.

It's up to you. What is you gut instinct telling you. Skipping the shot would be the same as a fur shot at the worst.
 
Well, I did another test and she was 481, so I shot 0.4. I was thinking about it, and I pre-filled the needles that were used while I was gone so I wonder if the issues may have been related to that? So I used freshly drawn insulin. I'll test every 2 hours and see how it goes.
 
AMPS: 481, shot 0.4
+1 428
+2 498
+5 335
+6 305
+9.5 188 Since this is after +6, I think her P must be working! Wish I could test past +12, but I will need to be asleep by then.
 
Hi Kathryn
Safe to assume no shot given? Very interesting numbers! Hoping she doesn't bounce and that all those high numbers are behind you. Looks like her P has reawakened!
Carl
 
Oh, Kathryn - I'm so sorry for the mess you came back to. Sounds like you're already well on your way to 'catching back up' though - so, that's good.

Looking good, Snowflake!

Libby (and Hershey, too!)
 
heh, hopefully I can catch back down ;) Unfortunately, I have a business trip next week, so I need to figure out something to do by then. I'm leaning towards using her again and just really educating her about diabetes and how it works. it's difficult though, because I'm only 25, and she's probably around 65, so the ingrained respect-your-elders thing makes me feel really uncomfortable about how I'll have to have the conversation, as I don't want to come off as lecturing her, but I can't let a repeat of what happened happen.

Anyways, yes, it is safe to assume no shot was given. Though I wish I had given something, maybe 0.2, since I woke up at +19.5 and she was 381, so I shot 0.4. I should be able to come home at lunch and test at +6, so I'm hoping it's at least 200's, if not 100's.

Also, I can't tell which cat it is since they share a letterbox, but one (or both) of them has runny poop. Never in the 14 years that I have had them has either one of them ever had runny poop--I'm hoping it will clear up in a few days now that I'm home, but if it doesn't, I think I'll be concerned. Is runny poop associated with anything diabetic related that I should know about?
 
Well, I'm 65 and if I was caring for someone's beloved kitty, I would want to do it right! Maybe write it down with a clear schedule of what to do when and if. (I do this for my 18 year old pet sitter and she has never acted offended. :lol: )

Unfortunate that she is giving the low numbers off schedule because it means catching her heading up and administering small amounts. Fortunate in that she seems headed in the right direction! I would plan to be diligent this week before you leave about keeping her below your target number with the small doses. It might mean some late night alarms, but the better you can get her regulated now, the better!

Have you set a target number? Some people use 150-180. I would suggest lowering the dose if your target number is in the low range - maybe even .1 at first? And committing to monitoring as closely as your life allows. Check out Catannc's spreadsheet. She was the latest to do the mini doses.
 
My target number is 99--I want her as close to normal as possible (her biological sister has been 50-55 whenever i've tested her), and I was getting numbers in that range before I had my double-dose snaffoo. When you do the micro dosing, do you go off the 12 hour schedule completely and only administer on rises? I'll take a look at her spread sheet.
 
Yes, it throws off your 12/12 schedule. You catch her when rising and near your target. (99 is a very gutsy target....if you are going with it, I would sure go down to 0.1 unit. I am nervous about a double digit target. We start in the 120 - 150 range just to be safe. Once you are more confident what her body is doing with the dose, you might lower it?)

Here is some more info on mini dosing:

When your cat is consistently in numbers too low to shoot at shot time and in numbers in the 100 range and below during the cycle, you can consider micro dosing. This process should be guided on the forum by experienced members and will require more frequent testing.

You may be shooting at times other than the 12/12 schedule, when the blood glucose levels rise enough to require a small dose of insulin. You will need to pick a number somewhere near the 150 range at which you will plan to shoot, being sure that the number is indeed rising. The dose at these low numbers will vary with each cat and its patterns, so advice should be solicited. But you may be considering doses below .25 and even considering a “drop” of insulin. At this point, U100 needles and the conversion chart will be necessary.

It is important during this period to offer small frequent meals. You may want to experiment with the lowest carb foods to help bring down the numbers, staying away from seafood more than once or twice a week.
 
Ah, by target range I thought you meant where we want them to be. Now understanding that that would be where you choose to shoot, I would probably set it around 150. However, I work full time and so my lifestyle doesn't allow me to check more often than every 4 hours (when I'm lucky) during the work day, so it would be nearly impossible for me to catch her right when she starts to rise. Is micro dosing still something I should do, considering my work schedule?
 
Oh, good. I didn't want to be discouraging but the 99 really made me nervous......

It can be done. Not necesarily easy, but usually the process is short. Cello's Mom did it while working full time. Maybe the easiest thing is for you to look at her spreadsheet: https://docs.google.com/spreadsheet/ccc?key=0ApRoVAkSuXuUdDltSnA3ZFVHQ3BUdlNLanJYRkQzSnc#gid=0 You don't catch her at the exact time she starts to move up, just around your target area and sure moving up. Some of it can be done at nights, if necessary, with the alarm or a few restless nights.

It's the best way I know to get a cat into remission. A short, frantic time, quite stressful, but with a big pay off.
 
So, lets say I shoot 0.1 and then 5 hours later she's rising again. Do you shoot another 0.1 then too? That's the piece I'm a little confused about right now. I would absolutely be willing to put in a week or two of really concentrated effort if it will work, but I want to understand the process fully before taking a stab at it.
 
I talked to Cellosmom a bit back when I was going through this, her goal was shooting anytime the number had risen above her target and it had been at least 8 hours since the last shot. I know tight regulation has people shooting as long as it is +6, I think +8 is safer. I think most people still shot 12 hours at the earliest since most kitties start rolling longer than normal cycles, I think Lise (cellosmom) never needed to shoot early and I know I didn't, seems once it gets going it's one shot a day at the most. But you may get a number you can shoot at +8, and I think that's fine to try.

Cathy
 
I'm with Cathy. Err on the side of caution. You want to make sure she has passed the nadir and won't be going down any further, so +8 would be safer. But you seldom would be shooting early. What "usually" happens is that you get longer cycles at lower numbers, not shorter ones - though every cat is different. The insulin is lasting longer and the pancreas is helping out, so you find yourself shooting at +14 or +16 - as soon as she is up to your target....
 
So, looking to Sunday on my SS, I should have stayed up to see when 190 rose and when it did immediately shot like 0.2? Is the theory that that should have worked with her P to keep her low, so she wouldn't have gotten up into the 380's by the morning? Or should I have shot 0.4 when she began to rise and not do the micro doses until she's lower than 200's?
 
Micro dosing to get a cat off insulin is typically done once you get long surfing cycles where you are getting longer than 12 hours per cycle already. If kitty is shooting up to 380 she may not be ready for this, but you don't know until you try. There's a chance shooting .2u may not be enough, Holly and Josie attempted to shoot micro doses below 200 but each time Josie would shoot back up. Holly ended up realizing that for her cat it was best to wait for the rise above 200 and shoot a normal dose, the cycles would run a bit longer each time and she went OTJ just recently.

Micro dosing for me worked because my cat for whatever reason would react to a 0.1u the way most cats would to a 1u, we didn't have much else to work with.
 
Okay, so I got home at +14 and she was 208. Pre all of the mess, I would've shot at this, probably 0.4. I'm thinking about shooting 0.2 to see what happens. I think that's little enough that I can shoot a full dose at +10 if she's much higher in the morning. Any opinions on that? As an intro of sorts to micro dosing? The 381 this morning was also at +19ish I believe.
 
I think I have confused you, and I am sorry. Looking at your numbers before your vacation, you were definitely a mini dose possibility. But I don't think Snowflake is back there yet. I should have checked out your ss better and not just answered the mini dose questions without relating that to Snowflake's specific numbers.

With your numbers yesterday, she is not back in a place where we can be sure what she might do with a given dose. (The data is all over; I think you need to start over and get some clear numbers.) Shooting the 208 last night was a little scary. It might have been high enough, but you couldn't be sure it was headed up.

I would start again, get an amps and a pmps daily and nadirs or midcycle numbers whenever possible. Maybe shoot your previous .4 or ask Robin to fix you up with a sliding scale. Once you get some data shooting regular 12/12 schedule (and maybe she slides back into the blues on a regular basis and has lower preshots) we can figure out what she needs. I would not be shooting off schedule at this point, even with the small doses, until you have more data.

I am also thinking you are going on another trip? Getting her on a 12/12 schedule with a consistent dose should maybe be our goal for now.
 
indeed it was definitely too early, but I only shot 0.2, which in the past has done almost nothing. I woke up at +11 to 410, so I shot about 0.55 since she's still just barely not into the 100's at nadir, and I don't like what last week must have done to her kidneys. I'll re-check her at +5/6 and see how it's gone.

I'm doubtful that I can get her onto a 12/12 because when I shoot a full 0.4, she's usually too low at +12 for another full dose. Yet shooting 0.2 didn't do much in the way of helping her bg levels. I suppose I could eyeball 0.3 for twice a day, but I'd worry that it wouldn't be enough?
 
I'd try the .3 (or what we call a fat .2.) You can determine with a syringe and water where you think .3 or a little more than .2 would be and mark it on the sample with tape or permanent marker. Each time you want to draw up the .3, put your new syringe up next to the sample so you know you are being fairly consistent.

If you can, finding a dose that will work 12/12 is best. If not, we will have to work around it.

I'd say right now, you need to get her back on track, collect some data and then solicit opinons on how to help her.
 
I have to agree with Sue on the .3u. If .4u is giving you low PS's than .3u is the way to go.

You will get the best results right now by getting her nice and steady on a 12/12 schedule.
 
0.4 is giving her low PS, but her nadir still isn't low enough, which makes me think maybe her system is holding onto the insulin longer? Or is it if I get her on a regular 0.3/0.3 schedule, the highs will go down and the nadir should adjust down accordingly as well?
 
I wouldn't draw any conclusions about the .2 because it was only one cycle. No, it didn't seem to do much of anything that cycle, but it might the next time you try it.
You could maybe shoot .4 if she's over 300 and .2 if she's under that? It would be best to shoot the same amount every 12 hours, but Snowflake has to buy into that plan. If she doesn't, you could try a simple "scale" to try to get consistent PS numbers. Then you might be able to tweak the curve with food and timing of meals.

Carl
 
Okay so basically just keep plugging along until she's more consistently in the 100's before starting to do micro doses?

I went home at lunch time and at +5 she was around 228 and then at +6 I think she was 208 (it's updated on my spread sheet, but I can't read it at work). I'm hoping that, as it's been the last few days, she'll continue down a bit from there since I won't be getting home until +14 tonight.

Thanks for all of the advice! hoping I can get her better regulated before I leave again and the sitter comes back (and it inevitably gets messed up again).
 
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