6/29 Morgaine's AMPS 198 ? about nadir

yesterday

Good day everyone.

Morgaine's numbers are bit higher and I do believe it is because we are doing a 10% carb diet now but she needs the lower fat too.

I understand that this is the patience period while the shed is filling so I guess I am wondering if I should be waiting for that to happen before trying to find her nadir. Some spoke of that on day 1, seeing if she had a nadir but pretty much all i am seeing is a flat curve now. This is cycle 6. Can someone take a look at her SS and give me some idea about where we are and when to test? I would like to test a couple of times a cycle but not much more unless absolutely needed. She cooperates but it is not without stress at this point.

Just want to say hello! I don't give dosing advice, but someone will come along soon that does.

Hope you have a great day!

Hi Rosalie,

You are doing great! Blues are nice and safe. The greens will come.

I was, and still am, very regimented about BKs feeding. I feed at +4 and +8 (and at the 12s). Besides PS times I would generally test him just before +4 and +8. Sometimes if he was running flat for several cycles that would indicate a drop was ahead.

I'm sure Morgaine will become less stressed with time. When we first started testing BK it took me & DBF to hold him down - and BK would grown and snap at us (he was an intact male back then).. With the help of freeze dried chicken treats (aka "kitty crack") it became very easy. You really are doing great!

Morgaine doesn't fight me and that is good. but she gets upset and especially because it sometimes takes a few pokes for me to get blood. She always gets a freeze dried treat or a meal and she knows this. I am just frustrated today because I had her ears bleeding well and now they seem to have stopped unless I keep poking in the same two spots, one on each ear.

Thanks for the feeding advice. I am pretty much there as well but we are still experimenting with some new flavors of low fat foods. They all have a slightly higher carb % but nothing over 10%.

I have read that the shed can take up to 7 days to fill so I am interpreting that as there may be no movement until after day 7. Is that correct? At that point we re-assess the dose?

Hi Rosalie!!
I think she is looking really great for having just gone on lantus. The protocol states:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

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I don't consider this to be a high, flat curve...she is in healing numbers. The goal with lantus is to be flat so it's good she is. Nadirs can move around and frequently do so I wouldn't get too attached to any particular time for a nadir unless you see it very consistently. She may be one of those.

After the 7 days, she may need just a tiny drop more but it's best to wait and see what she does.

Thank you Marjorie. You confirmed my understanding. I just wanted to hear it from a more experienced person with kitties. I am reading some of the excellent articles from the Queensland group and according to them, her PD is within the range of acceptable. She is not drinking >100ml per kg 24 hrs so that is encouraging. She is close to that but not over it. I will feel really good when we get into numbers where her drinking becomes normalized.

A good idea is to stagger your test times - some days, get a 3/6/9, and others you can do 4/8.
If you always tested at 4/8, you will never know if +6 is higher than both 4/8 or dips much lower.
Testing just a couple times per cycle is fine, just move them around to find the usual nadir. If possible, it is nice to do maybe a weekly full curve with a test every 2 hrs to get a complete picture of the curve.

Gayle and Shadoe said:

A good idea is to stagger your test times - some days, get a 3/6/9, and others you can do 4/8.
If you always tested at 4/8, you will never know if +6 is higher than both 4/8 or dips much lower.
Testing just a couple times per cycle is fine, just move them around to find the usual nadir. If possible, it is nice to do maybe a weekly full curve with a test every 2 hrs to get a complete picture of the curve.

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So do I do that even if she just ate? As I stagger, it will coincide with post prandial feeding times, sometimes by only 1 hr. I guess that would be the food bump.

At this point, I do not see her numbers moving much.

By checking at diff times, you will find out many things .... how long before shot kicks in, how sensitive to carbs/foods, etc.

For example, I did a great deal of testing upfront and now, I know how my two react and when I need to test.

I know that I don't need to bother testing Oliver before +4 because he is very slow to respond to shots and food doesn't seem to register for him. On the other one, Shadoe can and has reacted early, even as soon as +2 if the dose is too much or shed overflowing, and she is fairly carb sensitive, so I know some rise will be seen from her meals.
Oliver's nadir is late; close to +11, so I expect his numbers to rise till maybe +6, then fall.
Shadoe will be lowest around +5 and then start rising.

Once you have done a fair amount of spot checks, here and there along cycles, you will begin to see a more clear picture.
Study the ss and decide where would be best to test.... Always get a before-bed test because many cats are lower overnite, and if you wanted to see numbers near the end of cycles, you could get the odd +11, just to see if there is a rapid rise at ps or if there is little difference. Some cats rise pretty high and fast at the end of the overnite cycle - maybe revving up for the day?

All test numbers are data and you can never have too much data.

Sienne gave me a very good suggestion: always get a +2 as it can give you alot of information and I have found that suggestion to be invaluable. It's wonderful if you have kitties like Gayle's that are always the same.

M kitty and many others are not; the nadir moves, onset may move. I have recently noticed that my Gracie's onset has moved from +2 to +3 but I can tell by looking at her +2 if she is going to keep me busy or not. If her +2 is close to her PS, it's going to be a quiet cycle. If it is not within 50 mg/dl of +2, I can expect to be busy.

I agree with Gayle that, at first, checking different times will help you build up data so you can perhaps see a pattern. But in that suggestion, I would consider getting a +2 each cycle and see if you can make any correlations.

I will do a +2 in the PM cycle. Am aiming for a +6 next, in this cycle.

Thanks to all.

It takes a while to get to know your cat. Fundamentally, I agree with Gayle -- try to vary test times so you have the "big picture." Once you have a good idea of how Morgaine usually reacts, you'll know when it's safe to not test. (Of course, our cats tend to surprise us if for no other reasons than to keep us on our toes and to keep those treats coming.)

Like Marje said, the nadir is not a fixed point. It can change even from cycle to cycle. Right now, I wouldn't worry about the nadir. What you're seeing is a Lantus "curve" -- it's flat.

Is it flat because she is still filling the shed or can we just not know this until we hold this dose for 7 days?

Do I uncerstand this correctly, that until her shed is full the insulin is not really going toward lowering her BS and this is the reason for holding the dose for a week. In humans, this number would be too high and I would be increasing my dose but I do understand that cats are different. and/or injecting humalog if I were not on a pump. Since we are only giving Lantus, we have to wait to see how it lowers her levels once we are sure the shed is full, correct or no? I actually like the gentleness of Lantus. I loved it for myself as well after taking NPH for years.

Nadir is not on dry land; think of water surface and how it's always got a bit of a roll to it. If only there was such a thing as a cat whose nadir stayed put, but all you can hope for is the same general vicinity.

I know from past that Oliver has a late nadir, meaning it will be after +9 or later. For that reason, I hope that his BG is rising a fair amount until +4 because I know he is going to drop later. I know that I don't even have to test him till +4 because I don't expect to see much.

In time, you will have a full picture and know when you can save a strip or two because you are sure of what the numbers will be.
Just like a bounce after a low, there is not much point in testing much because you know the numbers are heading for the moon!

From what you are all saying, feline D is not that much different than human D except I know when I am heading into a hypo and I test and treat myself. The trick is to have the data to understand where the cat is heading. Yes, I get that and I am going to work at getting more data. I would test her a lot if I thought she would allow it with the stress I am seeing but stress effects glucose levels too. She is really good but it is a bit of a struggle if i do not hit the blood on the first poke. she gets up and leaves and then I have to corner her. I am most frustrated by not hitting blood the first time. Her ears look red and sore. i can see the blood under the skin. I also have RA and can not always get a good position going to test her but we are doing our best and I know if there ever is a serious issue with a low I will get what I need to get, stress or no stress.

Right now I feel pretty good about seeing that flat curve and knowing I can do less testing and scatter them at different times.

What you're seeing is a Lantus "curve" -- it's flat.

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These numbers are very close to the numbers I was seeing when I decided to start Lantus. I guess I am wondering if this is the Lantus or if the Lantus has not yet kicked in. She had been running 160-200.

Rosalie:

Are you poking her on the edge of her ear? We want to be sure and not poke the large vein that runs up and down the ear. If you put a flashlight on the inside of her ear, you can see the vein. You want to be sure that you poke away from that vein towards the outside edge of her ear as closely as you can considering your RA. I always have a cool, damp baby washcloth ready and as soon as I get my test, I put pressure on the poke spot with the washcloth to prevent bruising. If we're testing very often and also when we go to bed for the night and are done testing for the day, we put a tiny bit of neosporin Pain relief ointment (not cream) along the edge of the ear where we have been poking. A little goes a long way ;-) If you get too much, the blood will smear when you test but if you get just a little, it actually helps to bead the blood.

She does not bleed well. Sometimes all I can do is get the vein and it is bothersome. I have definitely tried, over and over and over to go between the vein and the edge and nothing happens. This is why i am so concerned. There does seem to be a spot where I can usually get some blood but I do not want to keep using that same spot. One ear is less sensitive than the other so she doesn't let me test the more sensitive one that often. My arthritis gives me little dexterity and that is also a problem.

I am allergic to neosporin so I will have to get some. I do have bacitracin but it doesn't have the pain relief. I will use that for now. She lets me rub her ears gently at night because it must feel so good to her.

I also poke on the inside of the ear as she has black ears and I can't see a thing on the outside. The vein runs up one side and around to the other side. Is it okay to poke on either edge of the ear?

Funny thing about the ears..... I don't aim for any veins, you don't need to aim for the vein but just near the edge. The ears 'learn to bleed' in time.
I am not sure why but Shadoe has paper thin ears and I poke on the out side of her ears; Oliver's are very fleshy and I poke his on the inside.
I know others warm the ears but I have never needed to warm them .... maybe it's helpful for some kitties though.
For tests, my cats pretty much sleep through the pokes, so I am lucky, but the odd time Shadoe needs some attention before she can be tested when she is not feeling well, so I take me time .... have her close beside you so that you can pat her and give treats as needed when you test.
I also know others poke freehand, but I have always used the lancet device as its spring feels to be quicker than any poke I could do and the depth is always consistent with the device. Once the device dial setting is to a depth good for the cat's ears, you should be able to get a decent drop.
Always know that the cats can sense your stress so be sure to treat the tests as nothing special and it will help eliminate stress.

Re: 6/29 Morgaine's AMPS 198 +6 180

Morgaine is not a cuddler, except at night in the bed. She will get up on the bed, sit down and allow me to poke her ear but if I don't succeed she gets upset and leaves, only to have me follow her into the kitchen where she awaits her treat. I have to let her know the test is first. Then she reluctantly lies on the floor and I have to stand there, bending over her to do the poke and test. I am unable to get down on the floor so all of this makes it awkard for me. That is why I would like to not be testing 8-10 times a day.

Just did a +6 test and she is 180. I do think I got the sweet spot because it was at the edge but it really bled. Do you sometimes get a lot of blood or am I hitting that vein? I actually got the illumavein but she hates it. she will not sit still with it on her ear and I can't get a good grip on anything else.

Hi Rosalie and Morgaine,
You are doing really well. Here's one more tip for getting the blood drop. Blood flows from the tip of the ear down (on either edge). If you put some pressure by pinching the ear just below where you plan to poke, it forms a dam and the blood drop will appear faster and better. I always use a little vaseline on the edge of the ear to help the blood to bead up.
After the last test of the day I put a little Neosporin creme with pain relief on the ear so it will heal overnight. I read that you are allergic to Neosporin, but perhaps you could apply it with a cue tip or a gauze square. I use the cream for the overnight healing because it absorbs into the skin and doesn't get tacky and sticky like the ointment does. It lets the ear breathe.
Usually one ear bleeds better than the other. I only use Rusty's right ear! And I use the lancet device. I agree with Gayle that it is more consistent and much faster than doing it freehand.

Have a good evening and don't worry about your kitty. She'll get used to the routine and soon won't mind those pokes.

Ella & Rusty

p.s. to answer your question about the amount of blood: yes, sometimes there is a lot more than other times. Maybe it's because we hit the vein. In any event, I always do the poke while holding a gauze square on the other side of the ear and then just fold it around the ear and put a little pressure on it to staunch the bleeding and cut down on any bruising.

Rosalie, I had to laugh.... Morgaine sure has the after-test part of the routine down pat.... test failed? Too bad. Treat now please!
I am glad you are standing firm; they have a way of catching on quickly and then twisting things to suit them!
you really are doing just fine, and in time you both will get better with the testing.

I always use a lancet device on myself and on Morgaine. I have at least 6 of them, some different and easier than others.

Yes, she is very smart and knows a treat is the reward and tries to get it no matter what. We are doing okay and I really appreciate the encouragement. The hardest test is the AMPS because she is used to immediate gratification for her hunger when I get up. Now she has to have that darn blood poke and wait for me to prepare the syringe for injection while she eats. She is pretty funny as she complains about the process but we are doing what is needed and I tell her that. She is getting the message.

Ella, thanks for the blood flow tip. I will try that next test.

The good news is that I have found her a low fat food that appeals to her and it is FF so much less expensive than Pro Plan and it has the same ingredients, including real chicken as the 1st ingredient.

Do any of you give your kitties FF appetizers as a treat? I got a few tubs of it because it has nothing but chicken in a broth and is low, low fat. Well, guess who loves it? So we now have variety, a little bit of the appetizer or a freeze dried treat.

Gotta love these babies who are smart as whips and know how to get what they want.