10/19 Buddy +12 193 PMPS 385 +2 354 +9 327

Yesterday

Morning all hope everyone has a good day !

Wow, eyes opened. Getting interesting readings. Picked up extra data last night and early this morning. I had set my alarm for 12am (bedtime is around 10) to get a +6 but slept straight through it. Buddy let me sleep till 5:10am. He has been waking me up around 2am and 4-430 am lately. While feeding him I took the opportunity to check his BG which is a +11 from last night's cycle - 206. He got a good 5oz. Evo 95%. When I checked him again at 6:15 gave him another 4oz or so, 193 - DID NOT Shoot. Still falling at 12hours past injection. . . . any thoughts?

Oh, and I finally broke down and turned on the heat to 68F. Ears bleeding so much better. Back to rubbing ears and using cotton ball with lancet pen. This combo seems to be the least intimidating to Buddy and he's bleeding pretty well. Hope that keeps up, easier bleeds mean I'll be able to check more often.

Tony and Buddy

Edit #1 after a few thoughts. It's been easier to get him to purr. Seems like all I have to do is touch him a few seconds. Also, second he starts eating his motor starts running as well. He hasn't gained any weight by my human scale (holding and subtracting my weight), but I swear he has just a bit more meat on his bones (almost imperceptible) and a bit more roundness to his tummy.

Re: 10/19Buddy AMPS 193n/shot

hmm no advice here, just saying good luck and hope you get some input soon

Re: 10/19Buddy AMPS 193n/shot

Morning Tony...nice number for Buddy this morning....but if you did not shoot, your header should read "AMBG" because it is not a preshot number...but the morning BG, okay?

There is a post that is floating around...sometimes it gets buried...Libby wrote it about low preshots. Maybe you could look at it and maybe print it for future reference> viewtopic.php?f=9&t=26571
It talks about different options for low preshots.

Since you had to leave for work, it is good that you did what you did....and it is good to see those extra tests last night. Good job! :thumbup I love your posts in the morning Tony...they are very informative! Did I ever tell you about the WCR (Whole Cat Report) We believe that our kitties are a lot more than just their BG numbers. We have 5Ps that are important to notice during each day....
P=Purring
P=Peeing
P=Pooping
P=Preening
P=Playing
So, when visiting other condos, you might see th8is written "All Ps present" or "3 Ps accounted for today". That's what that means! :mrgreen:

I found that using a folded tissue behind the ears gives a good solid backing for when I test....but if the cotton ball is working for you, that's a good thing! :razz: Whatever works! Has anyone discussed the effect of food on the BGs to you? We find that we should not feed them at least 2 hours before preshot time. So, if you time your last snack to be no later than +10, you will not see a food spike in that preshot number. I found that leaving 3 or 4 hours is even better for lowering the preshots. So, my late night snack is at +7 each night....just something to keep in mind.

Re: 10/19Buddy AMPS 193n/shot

When you read that post I linked for you, come back and ask any questions you may have. I am hoping that the dosing people will take a look at Buddy's SS. Lantus works best if shot at the same 12/12 with the same dose. This is the second morning now that you weren't able to shoot a low reading, so it might be better for Buddy if you once again lower the dose for consistency's sake...lets see what other say, okay Tony?

Re: 10/19Buddy AMPS 193n/shot

Morning guys! This is a great amps for buddy .. I hope he can bring himself down some without insulin so you see some green later on .. .have a great day guys!

Re: 10/19Buddy AMBG 193n/shot

Pat,

I know about the two hours pre test not giving food. Unfortunately, that is not for us right now. When Buddy wants to eat, he WANTS to eat. Trust me on this. The link was very informative. It looks like Buddy has a late nadire as evidenced by still falling from the +11 to AMBG even after he ate a bunch at +11. Will definitely need to ponder over this issue. Seems he might benefit from a decrease to get him back to 2XBID. Like you said, this is the second time in a row no AM shoot. Looking back to 12/13, I shot the low and he bounced back up. This could have been that he got into the dry food when the GF left the door open, it also could have been a bounce up from a low due to over dosing. . . The more and more I think about things and look at the patterns especially the high flat curve on Sunday, he's getting too much insulin. Seems to do better after a skipped dose. . .

Tony

Re: 10/19Buddy AMBG 193n/shot

Late nadir is AWESOME! My Oliver is one of those guys so if you stop and think about it, that's about the lowest he is going to go, and after the shot, he rises for at least 4hrs.
Once you able to gather more data, in particular, catch some +_10 and +11 numbers, you will be able to see what is happening at the tail end of Buddy's cycles.
I would not be skipping shots though; 193 is not too low to shoot.
Holding the food at the 2hrs pre-shot is important. If needed, feed right at the 2hr mark or give something that is not going to artificially mess with his numbers - I give raw chicken chunks to Oliver and Shadoe has some freeze dried ones if they are starving. that 2hr thing is important because you want true, pure ps numbers.
If you want to feed through the night, you can get yourself a 5section autofeeder, then you get sleep and Buddy gets food.
if you have the feeder set to turn at the 2hr pre-shot mark, he will learn quickly when he should eat.

Re: 10/19Buddy AMPS 193n/shot

Tony, that's a nice number! Along with that post that Pat linked, also take a look at the sticky on being data ready to shoot low numbers.

Many cats have a little dip from +11 to PS, Tinkles does that sometimes. Once you get more data, you will see if Buddy is one of those cats. Also, remember that there is some variance in the meter readings, up to 20% is considered within variance, so it would be considered essentially the same number. When you see that, you can stall and test again in 15 minutes to see if he is going back up...without feeding, so here's where the testing before feeding becomes important. I'm hoping that Buddy's hunger will calm down soon for you, and testing will continue to get easier so you will be able to get tests before feeding soon.

Just FYI.....the curve on Sunday shows a bounce...very normal! It doesn't necessarily mean that he is getting too much insulin, it means that he saw lower numbers than he has gotten used to, so his liver panicked and dumped sugar and hormones to protect from going hypo...it can happen when a cat that is used to yellows and pinks hits blue numbers, not necessarily a REAL hypo. However, I don't want to discourage you from lowering the dose so that you can shoot a 12/12 schedule consistently....that's a separate issue in my mind. You need to be able to shoot twice a day, that's very important, so if you need to reduce the dose to do that, then I'm all for it. See what the more experienced folks say.

Re: 10/19Buddy AMBG 193n/shot

I tend to agree with Gayle that a 193 is not too low to shoot -- but, I'm thinking you seem to need to have more data for your comfort level. Also, a 206 to a 193 is the same number. Well, not exactly the same number but given meter variance of 10 - 20%, a difference of 13 points is negligible. It's hard to not get wedded to the exact number, but you need to look at the bigger picture. Buddy was surfing. There is a phenomenon called a "double dip." I believe Libby referenced it in the post Pat linked.

I tend to think that if you aren't comfortable with these AM numbers, it may make sense to reduce Buddy's dose to 0.5u so you can shoot twice a day on a consistent basis.

The 193 is your +12. It is 12 hours past your last shot and you did not give any insulin. The hour count continues from your last shot. (We usually reserve the AMBG notation for a cat that's in an OTJ trial.)

With regard to PM spot checks, I'm a big fan of getting a +2, rather than a +1. The +1 usually reflects a food spike. If there's a substantial drop at +2, you'll know you need to do more testing in the PM cycle.

Re: 10/19 Buddy +12 193 PMPS 385

I see from your spreadsheet that you decided to reduce tonight. That sounds like a good plan. Stay on top of it so if that is not enough insulin, you can go back up.

FYI, I don't think you have enough data yet to say that Buddy has a late nadir. Yesterday's green looks like the result of a bounce that happened to clear as you reached preshot time. It's tricky to shoot those without data, so since you couldn't be home, skipping was a good decision. Today's blue looks like a surf and would have been fine to shoot. Getting the +11 was great - the fact that +11 and +12 were pretty much the same tells you that Buddy was no longer dropping and that the 193 was shootable. If he was 206 at +11 and then something like 125 at +12, then you would be more careful about shooting if you have to leave the house because he is still dropping kind of fast. Make sense?

Re: 10/19 Buddy +12 193 PMPS 385

Libby,

It is all starting to make sense. Except for one thing. After a skip, 0.75 seems to be good at getting his numbers to come down into a "reasonable" area. It also seems that repeated 0.75 might be too much, not so much as to cause a hypo, but to make him bounce which from what I understand will make it next to impossible to regulate him - he'll just bounce up and down forever, not something that would feel good or be conducive to going OTJ someday. Also, it seems in retrospect that even repeated 0.5 units is too much as evidenced by 10/6 to 10/9, he just kept going higher. Which is why I gave the 1unit BID, not realizing that he higher and higher numbers might have been b/c of a bounce type activity. What my thoughts are for now. As long as tomorrow morning I see a decrease into the yellow's or high blues, I'm proposing that I shoot an even lower amount of insulin, say a super duper skinny 0.5 or less. I know consistency is the name of the game here, but if I'm reading the patterns right, after a skip, he can come down at +12, but when I give that same dose, he just bounces back up. Along this line of thinking, it may have been prudent to try this approach tonight giving 0.75units and a super duper skinny 0.5 or less tomorrow morning and then hold that smaller dose to see if it keeps him lower without bouncing back up. Please don't give me too much lecture about moving doses around too much. This is a pattern that I believe I'm seeing coming about. Look at consistent 0.5units, worked great on 10/6, didn't shoot the low blue, he was still pretty weak from the vomiting/diarrhea and wasn't eating what he is now. Then it looks like it just propagates itself upwards to the reds. Which takes a dose increase to overcome it and he goes almost dangerously low, skipped does and took it back to 0.75 which ends him back into this bounce/rebounce cycle. Like after the bounce, 0.75 is enough to bring him back down only to result in more bounce where the 0.5 units couldn't overcome counterregulatory hormones and he just stayed high till I upped the dose to 1.0. I know I'm talking in circles a bit but to recap:

Hopefully 0.5 brings him down into the blues and he surfs a bit till morning
Decrease the dose in AM to perhaps 0.3 units or so to keep him low, but keep him from bouncing up
Hold that dose for days and get BG's

Keep in mind that fasting BG for Buddy is ~350-380, so if he is in this range or below, I might consider this a non bounce high? Of course, I still can't explain the 98 we had on 10/18


Tony

Re: 10/19 Buddy +12 193 PMPS 385

Also, keep in mind that from 0.5units on 9/30 he possibly surfed for days in the greens. I know he wasn't eating much, but he was eating and fasting BG is still in the mid to upper 300's. I believe (can't quote) when originally diagnosed at 370, he was not eating much and was very lethargic.
After I get his body adjusted to lower BG's then we can increase his dose accordingly w'o bouncing. Just a thought.

Re: 10/19 Buddy +12 193 PMPS 385

Bouncing is normal and it doesn't set up a ripple effect like you were describing. A bounce is due to Buddy not being used to being in normal range numbers -- the FD had caused him to be more used to higher numbers. As a result, when his numbers are lower than what he's become accustomed to, his liver dumps glucose and counterregulatory hormones to boost numbers up. As Buddy spends more time in lower ranges, his liver will get used to being in those normal numbers again.

Pretty much all kitties bounce. Some don't bounce as much or for as long. We refer to this period as "Liver Training School" (LTS). There is also the phenomenon of "new dose wonkiness" (NDW) whereby when you increase the dose, rather than numbers coming down the way you would expect, they go up for a cycle or two. These are all factors that you need to keep in perspective when trying to figure out what's going on and why it's important to let a new dose settle.

Re: 10/19 Buddy +12 193 PMPS 385

yep, I wish there was a way to get around the bouncing but almost every cat does it (some more than others). Sienne explained it well. Most cats will get to a point where the bounces get increasingly shorter and lower, then one day the bounces stop. It's pretty cool to see that happen and see the cat flatten out in blue or green.