4/1: Sammy - AMPS 71; +2 82; +5 78; + 8 82; +11 89; PMPS 86; +1 91; +2 100

[Tina & Sammy]

Yesterday's Condo

I'll just throw out what I'm thinking and let you consider it. Hopefully others will add their 2 cents worth as well.

I don't think i'm seeing an inverted curve. Most of the time it looks to me like a rise at the end of the cycle. Today is a little bit different and it looks to me a little like a mini-bounce. I wonder if he got lower last night. It looks like he was coming up at amps/85 and since he was at 82 at pm+95, he may have gone lower after that 82. Sometimes cats give a last hurrah on bouncing and you'll see something like this, just a few hours of being higher. No way to know and I certainly wouldn't stress about it, but it just makes me wonder.

If I were guessing, I'd guess he has an early nadir. I see several around +3-+5. Nadirs do move, though, and it's rarely consistent all the time. I'm just wondering if his eating post mid-cycle during the days is contributing to the higher numbers later in the day cycle. Feeding at +9 is one of those things that can work sometimes and not other times, depending on the phase the cat's in. I'm just wondering if maybe Sammy isn't quite ready for that +9 feeding at this point. You might try feeding him everything before +5 or so in the day cycle tomorrow and for a couple of days and see if it changes the second half of the cycle. Sometimes if cats eat in the second half of the cycle it drives up the BGs towards pmps because the insulin is waning at that point.

As far as the difference between the day and the night cycles, so many cats have their lowest numbers at night that it might explain the difference between the 2 cycles.

Anyway, some musings from looking at his ss. See what you think.

Hi Julie, thanks for the visit last night. I appreciate you insight. You say you think Sammy isn't quite ready for the +9 MiniMeal and probably shouldn't be eating post mid cycle, but I have been feeding Sammy right up until +10 since the very beginning. Even prior to the MM I would give food right up to +10 if he seemed like he wanted more, and most of the time I left food out for grazing.

The recent change is I have been allowing him to eat past +10 up until +10.5 especially if he hasn't eaten well earlier in the day/night. But this would not affect his +9 reading, only his PS number, and that has been going down from +9. So I don't think that could be the problem.

You also mention a possible lower number after +9.5 from 3/30, but again I personally don't think that is the case. I know I don't have detailed notes on my spreadsheet about what he eat and when. But he ate at +9.5 that night, and it was quite a big portion which was slightly larger than is regular MM portion because I am always nervous that he is going to wake me up before AMPS, and I really need my sleep. I am pretty sure that he polished off the snack all at once, but occasionally he will leave a small bit that he will eat 30-60 minutes later at +10-+10.5. So I really think the +9.5 to AMPS on 3/30 - 3/31 was more of a surf.

Which brings me back to the inverted curves and the big drops from +9 to PS for the last several days. I still think that he might be working on his own power and the insulin is just screwing with the numbers. Pretty much from the time he went on MM at 2.25 units to the .5u dose his numbers seemed to be fine and look stable and with a normal curve. Sure there were a few higher numbers, but nothing that was really wacky. But even going from the 1 unit to .75 he did have some higher numbers late in the cycle and then made big drops before PS. Once the dose was dropped to .75 and the depot was cleared of the 1 unit dose the numbers seemed to stabilize again.

Until 3/21 when the numbers started to be all over the place. He had lots of flat cycles, cycles with mid to late highs followed by lower PS, and cycle with straight up climbs. There weren't many cycles over the last week to 10 days that have made much sense.

Last night was the first cycle that seemed more right, but that was with fluids and a reduced dose.

I am still wondering if he is ready to come off insulin. My thought is that if I see another similar cycle to yesterday where he just climbs up the ladder all day and then makes a huge drop at PS then I will probably discontinue insulin. I know that there is still technically one more smaller dose we could reduce to, but at this point I think it would be better to just stop the insulin. Or the other option is if he gives me a low this morning then I will also discontinue insulin tonight.

If I see a more normal curve with out those spikes mid to late cycle then I will continue with this dose for another couple of days. It is possible the the .5u depot has been depleted and he is not working only on the .25u dose which might make a difference with his numbers. The last thing I want to do is discontinue insulin too soon and have to start back up again, but these inverted curves are freaking me out almost as much as the high numbers did in the beginning.

Hope everyone has a fabulous day!

 

[Tina & Sammy]

Still not sure what is happening here. This cycle is pretty flat so far, but also higher than AMPS. In the past, the cycles with fluids and the cycle or two afterwards have been pretty normal, so I might be sticking with this dose again tonight unless I seen a higher number at +8/+9 today.

 

[Tina & Sammy]

So even though Sammy didn't climb all that much I still think there is a problem because he had yet another inverted curve. I am just not sure if I sure stop the insulin or if I should go one more dose to see where he goes from here.

Has anyone else experienced anything like this, and if so what did you do????

I will be doing the PMPS test in about 30 minutes or so.

 

[Wendy&Neko]

I am not seeing an inverted curve. This was a lovely flat cycle. Remember the 20% variance allowed for the meters.

On Tight Regulation, we go from .5U to .25U to .1U before going off insulin.

 

[Tina & Sammy]

I am not seeing an inverted curve. This was a lovely flat cycle. Remember the 20% variance allowed for the meters.

On Tight Regulation, we go from .5U to .25U to .1U before going off insulin.

What about yesterday's cycle wasn't that an inverted curve???? And the day before.

When I think about the 20% meter variance I think about the fact that Sammy's number could truly be 20% higher or 20% lower than what the meter reading is. Not 20% different for each test. I don't think the meters are that inaccurate, but I do agree that there still could be some variance based on the meter. If I tested on two different meters I think you could see that 20% variance from one meter to the next. Whenever I do two tests back to back because the number surprises me I ALWAYS get a number within 1-2 points of the previous number, unless it was a bad strip.

 

[Sienne and Gabby (GA)]

I'm not seeing inverted curves either. You are correct in that there is a +/- 20% point spread around each number. So if you plotted it out, there would be overlap between the numbers you're seeing. Sammy's lowest number for his AM cycle was 71 and his highest was 82 -- these numbers are not different. It was a flat cycle. It's more likely that you're seeing a late nadir yesterday morning. The low point was at AMPS, numbers climbed, and were coming back down by PMPS.

FWIW, late nadirs make everyone a little nutty. They are hard to spot and it's sometimes hard to know whether to shoot. Some cats just have consistent late nadirs. Others, though, like to keep you guessing.

 

[Tina & Sammy]

He is still rising. Is there a way to tell if he is experiencing too much insulin verses not enough. I would think that if it was a not enough issue he would still be seeing a bit of a drop rather than such a flat or rising cycle. I guess I will continue with the .25 dose another cycle or too to see where it goes.

I guess if he continues to rise and then all of a sudden drops late in a cycle that will be my sign that he is getting too much insulin and we need to reduce.

Does that make sense??? Or am I completely Nuts???

 

[Tina & Sammy]

I'm not seeing inverted curves either. You are correct in that there is a +/- 20% point spread around each number. So if you plotted it out, there would be overlap between the numbers you're seeing. Sammy's lowest number for his AM cycle was 71 and his highest was 82 -- these numbers are not different. It was a flat cycle. It's more likely that you're seeing a late nadir yesterday morning. The low point was at AMPS, numbers climbed, and were coming back down by PMPS.

FWIW, late nadirs make everyone a little nutty. They are hard to spot and it's sometimes hard to know whether to shoot. Some cats just have consistent late nadirs. Others, though, like to keep you guessing.

So are you saying that yesterday morning's nadir was at PMPS?????????

 

[Wendy&Neko]

Neko did some nadirs as late as +13 when she was on Lantus, it can happen that they nadir late. Remember that yesterday, and possibly today, the depot is still adjusting to the lower dose.

 

[Tina & Sammy]

Neko did some nadirs as late as +13 when she was on Lantus, it can happen that they nadir late. Remember that yesterday, and possibly today, the depot is still adjusting to the lower dose.

So are you saying that the higher numbers yesterday morning where because he was still working off the .5u depot and that was probably too much insulin???

 

[Wendy&Neko]

No, rather that sometimes you can get wonky numbers when the depot is adjusting.

 

[Jill & Alex (GA)]

Well, this is the beauty of having a peer-reviewed message board. We can speak up if we want to offer a different point of view than what has already been presented.
Tina, I think you're onto something with Sammy.

Has anyone else experienced anything like this, and if so what did you do????

Yes, Alex was one of those cats who was famous for throwing me inverted curves. They're much easier to spot when kitty is on Lantus than on Levemir. Although, Alex had them on both insulins. Probably the easiest inverted curve to spot (which obviously indicates a reduction) is on Alex's 2006 Lantus spreadsheet (pre- TR days on the FDMB w/Lantus). Scroll down to the last week she was on Lantus and check it out. She was also seeing extended duration at the time.

When kitties are on higher doses of insulin we usually ignore inverted curves. However, I begin to pay attention when kitty gets down to those very low doses of insulin. The prudent thing to do (I admit, I haven't always been prudent) is to make sure the residual effects of the higher dose are gone before taking another reduction.

What about yesterday's cycle wasn't that an inverted curve???? And the day before.

Yes, I'm seeing the same inverted curves you're seeing. If you're nuts, then we're both nuts. However, it's also possible the inverted curves are caused by/helped along by the residual effects of the 0.5u dose.

If I were in your shoes (and have been), I would reduce the dose to 0.1u in the morning "IF" you see another inverted curve tonight AND Sammy gives you a green preshot number in the morning. If you see another flat curve like today's AM cycle, I would continue with the 0.25u dose for now.

Here's the caveat: Any time one reduces a dose because of unusual circumstances, it's a risk. The risk is you've misread the data and have to take the dose back up. Only you can decide whether to take the risk or continue with the current dose until Sammy either "earns" a reduction or maintains green for a week before taking the next reduction.

FWIW, just my thoughts and observations...