The Ultramarathon Part 5

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Kris & Teasel

Kris & Teasel

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AMPS was (FS) 10.8 - about (AT) 10. I gave him 2.65 u again. He's having nice AMPSs at this dose but there's some later in the day bouncing that raises his PMPSs. Nothing has changed about his food, fed amounts and feeding schedule so I'll continue to ride out these (frustrating) numbers. That column of nice AMPS numbers recently tells me we're getting somewhere. :cat:
 
Well, B-I-G bounce! BG at +7 was (FS) 22.3 or about (AT) 20.7. It's not from food because I've been out since +3 and there's no contraband laying about. Must be squirrels again ... :confused:
 
Those darn squirrels! That's too bad, but you did have a lovely preshot this morning...hopefully it will be good again tonight.
 
StephG said:
Do you feed just twice a day? Looking at your spreadsheet again and was wondering.[/QUOTE
Hi Steph,
Teasel and my other two cats are fed AM, a smaller meal mid-day, and PM, so three meals. I do Teasel's mid-day BG just before that small meal. Teasel usually spikes after eating and if/when I do a BG at +2 or +3 AM or PM it generally shows up.
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AMPS surprise!!! His BG was 4.8 using an AT strip. I retested immediately with a second AT strip and got 3.6. I'm not too fussed about the different numbers given meter reading variance, etc. The average is 4.2 but I've put the 4.8 on my SS.

Teasel himself is in fine fettle - bright, energetic, etc. In fact, when I saw him this AM I thought to myself, "I'll bet his BG is very good this morning." And, yes, it is - a bit too good! There were no signs of peeing outside the litter box that I saw in early August when he'd been on 3.6 u for three weeks without FDMB monitoring. I can't be certain but I attributed that peeing (after the fact) to him nearly hypoing overnight on that high dose. Only guessing but I haven't seen anything like it since.

I'm not giving him his shot this morning but am looking for input on how to proceed because this is new territory for me. I'm certain that I gave him his stated dose last night because I double and triple check the insulin level in the syringe every time before shooting. The only other factor that was different at last night's shot time was me moving his injection site from the upper shoulder blade area down to midway to his elbow, another area of loose skin. I usually use the upper shoulder/scruff "saddle" area because I have a hard time holding the skin pinch and he's told me before that he doesn't like other injection sites. I decided to try a bit lower near his elbow last night and was successful in getting a good, tight skin pinch and painless injection. It's quite possible that this morning's number is due to enhanced insulin absorption.

My plan is to do some testing periodically today to see how this plays out. I expect a high BG at PMPS. I was planning to vary his injection site more going forward because the usual area needs a rest. I'm a lot more skilled at giving the shots in spite of my problem hands and I'm less fussed if I hear the occasional squeak from him if a shot stings. I now know I need data that gives me an idea of how much his response varies with injection site.

Thoughts?
 
Well, he has been generally dropping for am but that was a surprise! I don't know if the injection site change made the difference. Some people think it really does; some see no difference. Yes, with your analytical mind, you'll do some research :D

You had to skip and yes, tonight will be high. If you stick with your method, you'd reduce tonight's dose, even if he is high? I don't think there is a right or wrong. Just data gathering. I'd say that the dose for a 257 like last night may need to be skinnier but I don't want to mess up your data by suggesting more if the number tonight is real high.
 
Sue and Oliver (GA) said:
Well, he has been generally dropping for am but that was a surprise! I don't know if the injection site change made the difference. Some people think it really does; some see no difference. Yes, with your analytical mind, you'll do some research :D

You had to skip and yes, tonight will be high. If you stick with your method, you'd reduce tonight's dose, even if he is high? I don't think there is a right or wrong. Just data gathering. I'd say that the dose for a 257 like last night may need to be skinnier but I don't want to mess up your data by suggesting more if the number tonight is real high.
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Thanks for this, Sue! I'm not sure about injection site effect either but that was the only thing that was different. Probably just Teasel being Teasel ... I will try varying the site if I can manage because his shoulders do need a break.

I probably won't lower tonight's dose much even if it's high. He might have been better with 2.6 u last night but who knows? It's amazing that he can respond differently to a 2.6 u than to a 2.65 u! I'll wait and see.
 
Just had an excellent conversation with Teasel's vet! She's been good about trusting my judgment all along but I hadn't gone into the details of what I've been doing the last two months since joining FDMB. I felt it was time that I tell her all about it so I emailed her a link to our "Advanced Techniques" Sticky as well as his SS and outlined what I do and why. We spoke on the phone a few minutes ago and she's totally on board with it, thinks what I'm doing is logical, knows how hard Teasel is to predict and views the client-vet relationship as a collaboration. I'm the ONLY client in this very large practice that's using ProZinc so I'm breaking new ground for them. They're up to speed on treating complications like DKA though because they run one of the very few 24 hour ER vet hospitals in the city.

I'm feeling relieved that she's completely in the loop now. :)
 
PMPS is (AT) 23.8. It's one hour earlier tonight because I didn't give his AM dose. I'm dropping his dose only a little to a skinny 2.6 u (2.55 u on SS) because it'll be 13 hours until tomorrow's AM dose. I'll do a test before bed tonight and give a snack if necessary.
 
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BG is 5.4 at +5 after PM shot! Huge drop from PMPS. I used the same injection site as this morning - lower down from his shoulder toward his elbow. Is this low number dose related or absorption related???? Gave him a snack of his regular food.
 
BG at +8 after PM shot (snack 3 h earlier) was 9.4. Huge bounce number this morning for AMPS - 26.9. I decided to lower his dose to 2.4 u because I'm trying to inject in other areas.. His scruff/shoulders need an extended break and there might be an absorption factor affecting BGs. I might have had a fur shot this morning - full or partial - because I'm not practiced (yet!) at grabbing skin elsewhere and he doesn't like shots outside the shoulder/scruff area. Not a good way to start the day after my fractured sleep last night ... :banghead:
 
Wow! Teasel is sure giving you some crazy numbers! It could very well be absorption related. As Sue said there's no clear consensus on whether different injection areas cause different reactions to insulin. Could be an ECID thing I suppose.

I think lowering the dose was good considering we don't really know what's causing the low numbers. Can always go back up if needed.

Glad to hear your vet is on board! It's great that they are so encouraging.
 
PMPS is (FS) 24.1, about (AT) 22.7. Today's numbers might reflect too low a dose but I'm trying 2.40 u again tonight to see what effect the alternate injection site might be having.
 
:banghead::banghead::banghead:!!! For sure a fur shot tonight - I could smell the insulin on his fur. Now I know that ProZinc has an organic solvent smell although not as strong as Lantus' odour. I HAVE TO persist in perfecting shots outside the scruff/shoulder area but it's hard for me. However ..... I don't give up!
 
I was giving bunny shots lower on his back about an inch from the spine and found it worked well. I don't think I could have managed doing the elbow. Kudos to you! Apparently the side and flank are also supposed to be good sites.
 
AJHJ said:
I was giving bunny shots lower on his back about an inch from the spine and found it worked well. I don't think I could have managed doing the elbow. Kudos to you! Apparently the side and flank are also supposed to be good sites.
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Thanks, Angela! I welcome all advice. I'm trying to use areas where Teasel's skin is loosest. I need to be able to pick up a sizeable chunk of skin because the hand I use to grab it is very weak with a thumb that's next to useless. If I had normal hand strength, this would all be a piece of cake for me. I used to have excellent manual dexterity - not any more! :confused:
 
Even more impressive you got an elbow shot in! Bunny has loose skin everywhere so I'm a bit lucky, I guess :). Not to mention, I can do anything while he's eating and he doesn't even notice!

A bit of aside...I am so impressed with how scientifically you are approaching dosing Teasel. I've learned a lot from you and really enjoy reading your threads and responses to questions posed by others.
 
AJHJ said:
Even more impressive you got an elbow shot in! Bunny has loose skin everywhere so I'm a bit lucky, I guess :). Not to mention, I can do anything while he's eating and he doesn't even notice!

A bit of aside...I am so impressed with how scientifically you are approaching dosing Teasel. I've learned a lot from you and really enjoy reading your threads and responses to questions posed by others.
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Thanks so much, Angela. This is high praise ... I have a science degree and spent most of my career teaching physics and chemistry so it's my way of functioning in the world. I'm a problem-solver by nature and Teasel's diabetes is grist for the mill! ;)
 
Ah... a kindred spirit! I am a scientist by training, too. :). I remember one post where you mentioned trying to visualize the physiology and what Teasel's body was doing--I tried to take the same approach with bunny. It helped to think about it objectively when it felt pretty emotional at times.
 
AJHJ said:
Ah... a kindred spirit! I am a scientist by training, too. :). I remember one post where you mentioned trying to visualize the physiology and what Teasel's body was doing--I tried to take the same approach with bunny. It helped to think about it objectively when it felt pretty emotional at times.
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Yes!! I find it helpful to step back and look at an FD kitty as a system and the frequent BG testing is what makes its functioning a bit more transparent. That helps me to stay calm/sane when it threatens to overwhelm me. The bonus is that I'm learning new things which I love to do.
 
SUCCESS!!!! :):):) AMPS was (FS) 25.3 or about (AT) 23.5. I gave 2.4 u because I still haven't assessed site effects properly. That insulin was going into that cat come hell or high water - and it did! No fuss, no muss, nice poke into his rib cage area, no wetness or insulin smell. And not a squeak from Teasel ...
 
BG last night at +4 was (FS) 18.6 so I thought, "Small bounce." AMPS today was (FS) 8.2! Am stalling and will retest with AT strip. Both shots yesterday were successfully given along his side/rib cage area. I still don't know whether injection site is having a major effect but it might have some effect, given that this lower dose of 2.4 u seems to be working. :confused:
 
After 20 min stall, AMPS was (AT) 10.9. I'm dropping the dose to 2.2 u because when I gave his regular dose (2.65 u at that time) in AM of 10/10 at a PS of (FS) 10.8, around (AT) 10.0, he had a high mid-day (mini bounce?) and then a too low to shot AMPS of 4.8 next day, 10/11. And that was before the injection site change.
 
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Rachel said:
Sounds good! I have to say it really seems like the injection site is changing the game!
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I think you're right - who knew?! I had to think long and hard about different ways I could use my crappy hand to hold the skin elsewhere on his side but I found a way that works. And I'll get better with more practice. Persistence DOES pay off! ;)
 
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