Need advice re: AMPS 90/ 87/ 88/89

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Robin&BB

Robin&BB

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Ok, this is getting weird!

PLEASE, Sue or Lu or somebody, look at her SS and tell me: Do I feed her a little, or do I keep waiting 20-25 min., retesting - & withholding food - until her #s rise on their own? FYI: She has been much more active last 2 days & nights. (Sorry I was too exhausted last night: slept right through the +4 & +6 alarms I'd set - sorry.)

Would obviously skinny down her dose this AM if I can ever get a # I can shoot!
After 3 retests, is looking like a nadir @ 12+ hrs? DO I FEED HER SOMETHING NOW, OR WHAT???
 
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UPDATE: Finally reached vet - Given 4 retests this morning w/very slow rise in #s (to 103 by 9:37am), vet said go ahead & feed her, then check #, then shoot if @180+. Said to keep dose the same as we've been at; no reduction. Dang, this is puzzling, almost as though she hit nadir @ 12+ hrs??? I'm wondering if late night snack is appropriate to keep her more even.

UPDATE #2: Now I've REALLY screwed up! Actually FORGOT to retest 1st after she ate: just spaced out & gave her the shot after she finished food. Then realized what I'd done, retested immediately, & got only a 135. CRAP!!! What a moron! So fed another oz. of higher carb foor (w/gravy) & will retest shortly. Something tells me this is gonna be a long day. Ugh.
 
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I think an evening snack would be good; it could even things out. I think shot at 180 is okay, but then I would wait 12 hours before the next shot. I do disagree with the vet. Most often we see an unshootable pre shot number when the dose is too high. So I would lower the dose with the next shot, whenever it comes. Maybe back to 1.75 and leave it for a while.

My guess is that her insulin needs are lowering as she feels better and adjusts to the insulin. It could also be that she needs more than a few cycles to settle into a dose (unusual but possible) and you won't see the real change until then. But I definitely think she needs less insulin.
 
Sue and Oliver (GA) said:
I think an evening snack would be good; it could even things out. I think shot at 180 is okay, but then I would wait 12 hours before the next shot. I do disagree with the vet. Most often we see an unshootable pre shot number when the dose is too high. So I would lower the dose with the next shot, whenever it comes. Maybe back to 1.75 and leave it for a while.

My guess is that her insulin needs are lowering as she feels better and adjusts to the insulin. It could also be that she needs more than a few cycles to settle into a dose (unusual but possible) and you won't see the real change until then. But I definitely think she needs less insulin.
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Sue, I just REALLy screwed up. Fed, per vet, then shot @ FORGOT to retest! So retested & got a 132; immediately fed 1.0 oz. higher carb w/gravy. Just now retested again - got a 168. Should I test her again in another 1/2 hr or what?
 
Vet told me to keep her dose the same as yesterday, btw - a skinnied 2.0. Maybe he wants to see if she settles into this? This is all too confusing. (Can you tell I'm really stressed this morning?)
 
Today, I would definitely retest in 20 minutes or so. The food probably brought her up to 168. She will probably stay up and may even go fairly high. (Just a little high carb food can really raise the numbers) or she may drop again. If she drops, then I'd give her a little of the gravy off the lower carb. You want her to continue to eat for you if she needs to so we don't want her to get stuffed.

My thinking is that once you get a pre shot too low to shoot, she has settled in and is telling us the dose is too high and lasts too long. I wonder if we'd stayed at 175 whether in a few cycles she would have dropped lower. It seems to me that she is definitely needing less insulin.
 
Hi again, Sue - Just got a 189 BG @ 11:06, thank goodness. I'm thinking along the same lines you are - dose a little too high?

But vet said, "No, don't reduce it." I guess I'll be doing the full curve thing today - do you agree that's a good idea? Thing is, her #s were fine during the day yesterday ... EXCEPT that I noticed her #s dropped really quite late in that 12-hr cycle.

Maybe that low PMPS I got last night (requiring I wait 15 min, then we got the shootable 184) should have given me a clue to skinny the pm dose back toward 1.75 U. Had I not fallen asleep so deeply as to miss both overnight BG checks (still recovering from staying up 2 nights in a row-!), I suspect I'd have seen that same pattern: NO significant BG drops until very late in that cycle, too.

How else could those low AMPS tests (staying low for over 1.5 hrs.) make much sense? While I heard what the vet said this morning ("maintain the dose"), my instinct is that IF she does the same pattern of super-late nadir in the daytime cycle, it might make more sense to lower the dose just a wee bit for the pm shot - say to a slightly fat 175 or even a straight 175. Really, she's not at a full 2.0; it's more like the halfway point btwn 1.75-2.0.

Or ... do I have my head where the sun does not shine??? :confused:
 
I am thinking we can see a bit of a pattern. So we lowered her to >1.75 She was pretty good for 3/9 am and pm if a little higher than perfect. So then<2 on a lower pre shot than 252 the day before gave you a 103 at +6. On the Alphatrak, that is a green. Then the next cycle, same dose on a pre shot 70 points higher gave you a 100 (another green for AlphTrak) at +4. 3/11 same dose on 225 gave you a 170 at pre shot. (small warning about maybe a little two much insulin, yes) Then same dose on 184 gave you low preshot this am.

So, maybe it takes her 5 cycles to see the drop starting on a new dose. She gives you some indications with shots in nice ranges and lower pre shots. Then bam, she gives you a big wake up with a 90 for a preshot. Either she dropped very low overnight or the insulin is lasting too long. I think her pattern is not to drop that low overnight because she wouldn't have been still dropping this am. I think her pattern, when the dose is too high, is that it lasts more than 12 hours.

You are doing great, btw. This insulin is harder to get your head around than Lantus because with Lantus, the TR protocol uses hard and fast rules. If the number is this, shoot this. You can do that more comfortably because it lasts a little longer and has a shallower curve so you have more room to react if the number does dip low. I think we tend to be more cautious with ProZinc as it has a deeper curve and if you get lower numbers, you have to react faster. (the converse good part of that is that if you are headed low, by +12 the curve is usually back up and the numbers rising. Hypos on Lantus can last for several cycles)

With ProZinc, we rely on the past info. (why we love data) So looking back, the lowering pre shots and the lowering numbers mid cycle could have been a sign to back off a tiny bit. And yes, you are doing tiny adjustments, which in my mind, says she is sensitive to minute changes in dosage.

I asked BJ if she would help with the AlphaTrak ss. I think it would be real helpful because I think we see a 120 and see a blue. When on the AlphaTrak, that is a green. We may be dosing a little heavy just looking at the colors and not remembering to convert. Here is the scale if you want to keep it handy

red 400-499
pink 321-399
yellow 235-320
blue 134- 234
green 69-130
<68 low

I hope that helps and doesn't complicate things more.:(
 
Sue and Oliver (GA) said:
I am thinking we can see a bit of a pattern. With ProZinc, we rely on the past info. Here is the scale if you want to keep it handy. I hope that helps and doesn't complicate things more.:(
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Thanks for your input & the scale. (Ha! We must think somewhat alike: I just copied that scale last night. :woot:) Right now, she's already dropping: 141 BG @ +2. So my plan is to do checks @ +3 (I'm paranoid, I guess) +4, +6 & +8. (She's asleep on a chair right beside me.) I think you're right: that she's holding onto the insulin longer, esp. after her pm shots.

So you think a slight decrease toward or =1.75U tonight would be prudent? (My biggest fear is that if I hit her with yet another skinny 2.0 tonight, we'll be in real danger of going hypo sometime overnight.)
 
I do think I would get some tests in. She could drop low again. And she could be lower tonight than you want to shoot. Or she could jump up (bounce +higher carb)

Either way, (high enough or pretty high) I'd pick something under 2 - maybe a fat 1.5 and see how it does. Even if she doesn't drop into the greens mid cycle for a cycle or two, I'd give that dose a while and see if the pre shots gradually lower and the nadir's gradually lower. If not, you can raise a smidge. If so, then we have a good dose for now or may need to reduce more.

It might be a good idea to pick up some .5 unit U100 needles. If you want to make small changes (which it seems she
likes and needs) they would be easier to switch doses from 1.2 to 1.4 etc. You will need to use the conversion chart to use U100 needles and U40 insulin

http://www.felinediabetes.com/insulin-conversions.htm
 
Yep, we just hit a 68 @ +3, so I immediately gave her a dinky (0.75 oz.) snack of low-carb chicken pate. (As I would like a quick nap w/o any more nail-biting before +4 time.) I still have some U100 syringes from Lantus days: marked to 0.25s & shorter needle (which were easier, as there isn't much tent to grab on her). I was trying to avoid having to do conversions, but the chart will guide me! At least that way, I can be sure I'm being more precise with these micro-adjustments.

Based on what I'm seeing so far, I expect we will be skinnying down her dose some tonight, regardless of that "...maintain same dose" edict from the vet. (Ha! No disrespect, but he's not the one who'll spend another sleepless night with her if it's too much insulin for her body to handle.) ;)
 
Update for Sue: After dipping to 60 @ +4 today (too low on an AT meter), I immediately gave Bat a small gravy snack --- & we were up to 73 @ +5.
Kept a close eye on her rest of the day and - boy! -was I happy to see that 226 PMPS! In view of her low-down AMPS #s & the deep dip at nadir today,
I went with a "fat" 1.5U tonight. (Better to err on the side of caution, right?)

I'd be quite content with low 200s at pre-shot & blues in mid-cycle for a few days (hopefully this redux will effect that for us), rather than risk yet another roller-coaster ride for her. (And sure don't want a "super-low" happening in the middle of the night either!)

Thanks for your sage advice. (Once again!) I've gotta hand it to Bat: She's being a real little trooper through all of this, with rarely any fuss at ear-stick time.
 
Sue and Oliver (GA) said:
I'm glad Bat Bat is doing so well, attitude and number wise. It'll be interesting to see how your 1.5 works.
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Look like I may need to skinny down the 1.5u.
As today had 150 AMPS (took Bat 40 min more to rise to 184), then a 42 at +4; gave snack & she went to 67 a half-hr later. Any thoughts on this?
 
How to Handle Hypos
Please read over these instructions.

When she goes below 68, you need to start feeding 1-2 teaspoons of gravy from a high carb food (ex Fancy Feast Gravy Lovers), or 1-2 teaspoons of food with a few drops of Karo on it.
Then, every 30 minutes, you re-rest, and repeat for as long as she is too low, until you are past the nadir, and she is rising 3 times in a row.
 
BJM said:
How to Handle Hypos
Please read over these instructions.

When she goes below 68, you need to start feeding 1-2 teaspoons of gravy from a high carb food (ex Fancy Feast Gravy Lovers), or 1-2 teaspoons of food with a few drops of Karo on it.
Then, every 30 minutes, you re-rest, and repeat for as long as she is too low, until you are past the nadir, and she is rising 3 times in a row.
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Thanks, BJ. Yes, I immediately took action when I got that super-low # & was relieved when she finally popped back up to a 95. Tested her an hour later, though - just to make sure she kept rising (she did). Spoke with the vet & he agreed that I should drop her down to 1.0U tonight. Will monitor her overnight just to be sure she's safe. (Bat seems to be one of those cats who doesn't exhibit any overt hypo symptoms.)
 
What an interesting pattern. It seems like she has one or two higher cycles with a lower dose change (downward) and then she starts to gradually lower in general. And then really lower. :D
 
Sue and Oliver (GA) said:
What an interesting pattern. It seems like she has one or two higher cycles with a lower dose change (downward) and then she starts to gradually lower in general. And then really lower. :D
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And it gets even weirder: A 3am +5 of
130 AND an AMPS of 120 (!) at 10:11am. So right now we're waiting for BG to rise. Arrrrgh! So what's this about? A nadir at shot time? What the heck???
 
My guess is that her pancreas is working every once in a while. While this is great news, it does make your life more complicated. It is much harder to dose as patterns are harder to find.
 
Sue and Oliver (GA) said:
It is much harder to dose as patterns are harder to find.
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Sure is! And with no callback from vet at time of 5th ear prick - at which time I got only a 146 @ 12:15 pm from one VERY p**sed-off cat - I gave up & fed her - NO SHOT.

Decided is better to withhold the dose & monitor without the insulin in her system this cycle, so that I can see where her #s go & better gauge what her dose should be this pm. (i.e., 1.0U or 0.5U) based on how high she tracks today. And this will at least enable us to get back to a saner dosing schedule.
(Who'd want to be doing a PMPS/shot at 12:30 am???)

All I can say is: Poor Bat's so tired of too many repetitive ear pokes, and I'm just ... so tired. (And a wee bit frustrated.)
 
Crazy, crazy day! Have tracked her BGs with NO insulin since 10:30pm Wed. and she hasn't risen above 230 yet. Vet called a little bit ago & agreed this is a weird one; has never seen a cat do this kind of trend this quickly. So if she creeps up above 290-300s by PMPS time (7:00pm), feed then shoot only 0.5 & monitor around usual overnight nadir. If she stays in low to mid-200s, said to withhold the shot & we'll see what # she pops at AMPS time tomorrow morning.
He said, "Well, apparently Bat really wants to be off the insulin ..." We'll see. I'm not going to get too excited yet, as this seems awfully early for her to be going OTJ.

One sidebar note: Told vet that Bat's final dose of antibiotic Orbax was at 3:30 pm Monday --- and that I noted package insert lists "malt flavoring" yet neglects to list ingredients of that flavoring. So wondered if that could possibly factor into this sudden drop in BG #s over last few days? He found that intriguing and remarked that it makes one wonder if the malt flavor in Orbax does, indeed, contain something like corn syrup. Said that could be a possibility.

Anyway ... wish us luck. (Could be another interesting night here.)
 
Wow! Keep it up Bat! Those are some lovely numbers lately...especially since they are on an AT! Cats DO go OTJ on their own schedules...some in a very short amount of time, some never.

The info about the Orbax makes me wonder. It seems like it may be part of the issue. Keep us posted...and don't forget to get some sleep when you can! I well remember the tired feeling of weird numbers...
 
The Orbax thing is interesting. Yes, that could elevate the numbers and now that it is getting out of her system, cause some lower than usual numbers.

Robin, do us a favor and start a new thread. You have two going and they are both pretty old. I keep getting lost. It doesn't take much .:D
 
Rachel said:
Wow! Keep it up Bat! Those are some lovely numbers lately...especially since they are on an AT! Cats DO go OTJ on their own schedules...some in a very short amount of time, some never.

The info about the Orbax makes me wonder. It seems like it may be part of the issue. Keep us posted...and don't forget to get some sleep when you can! I well remember the tired feeling of weird numbers...
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Thanks, Rachel! Will let you know if I find out any more about that flavoring in Orbax.

I think Bat did fairly well, considering she hadn't had any insulin since 10:30 pm Wednesday night, 3/18. I fully expected to see an AMPS well over 350, so was pleasantly surprised to see a 323. We'll see how she does on the reduced dose of 0.5U today.

And I must say: Getting a full night's sleep last night was LOVELY. Yowza, I feel like a human being again! Funny thing, though: I woke automatically at 2 a.m. (without a set alarm) for that pm-cycle +4. Then I remembered I didn't need to get one ... ha, took me all of two minutes to go back to sleep! :woot:
 
Sue and Oliver (GA) said:
The Orbax thing is interesting. Yes, that could elevate the numbers and now that it is getting out of her system, cause some lower than usual numbers.

Robin, do us a favor and start a new thread. You have two going and they are both pretty old. I keep getting lost. It doesn't take much .:D
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Gee, and I thought I was the only one getting lost!:rolleyes: Will do: Will name thread: OTJ one day ... & back on again!
 
Robin&BB said:
Sure is! And with no callback from vet at time of 5th ear prick - at which time I got only a 146 @ 12:15 pm from one VERY p**sed-off cat - I gave up & fed her - NO SHOT.

Decided is better to withhold the dose & monitor without the insulin in her system this cycle, so that I can see where her #s go & better gauge what her dose should be this pm. (i.e., 1.0U or 0.5U) based on how high she tracks today. And this will at least enable us to get back to a saner dosing schedule.
(Who'd want to be doing a PMPS/shot at 12:30 am???)

All I can say is: Poor Bat's so tired of too many repetitive ear pokes, and I'm just ... so tired. (And a wee bit frustrated.)
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You might try poking the paw pads, my vet says they don't have many nerve endings there, my kitty tolerates it very well. Just make sure you rub the paw a little before poking to pull some blood down into it.
 
Mogmom said:
You might try poking the paw pads, my vet says they don't have many nerve endings there, my kitty tolerates it very well. Just make sure you rub the paw a little before poking to pull some blood down into it.
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Oh, you're so lucky to have a mellow kitty --- I wish Bat would let me do that. Can't go there. If I even tried that, I would need a tourniquet. For me, I mean!
 
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