? 4/27 Tuxie AMPS 191 after days of hig &flat.Shooting lower right thing to do? PM BIG Bounce

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Tuxedo Mom

Tuxedo Mom

Member Since 2014
ALPHA TRAK 2 PET METER

Yesterday's post:

http://www.felinediabetes.com/FDMB/...-342-still-high-and-flat.136904/#post-1412121

For the last 3 days since Tuxie's last dose increase he has been running high and flat. However this morning his AMPS shot was 191 (AlphaTrak meter) so something is going on. I never tested after +5 last night so I have no idea what went on over the 7 hours in between the two tests. I shot .25 units less (5.50 units) and will monitor carefully this morning. +1 is 240 one hour after eating. Tuxie usually goes up for the first 2-3 hours after eating,


I had used the test solution yesterday to check the meter and it was good. Also I ran several tests this morning for AMPS and still got the same number range.

Was this the right thing to do...now that I am totally awake I am getting nervous about this sudden response? In hindsight I think I should have waited and tested again before shooting :(




 
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Tuxie bounced after the last blue numbers. What you're seeing is that the bounce broke, most likely during the latter part of yesterday's PM cycle. There are two factors involved. It can take up to 6 cycles for a bounce to clear and it can take the same amount of time for the depot to adjust to a dose change.

You need to give some thought to what numbers you're comfortable shooting. Ultimately, since you're following TR, you'll want to consider shooting low numbers. I'll shoot the full dose for any number above 50.
 
Sienne and Gabby said:
Tuxie bounced after the last blue numbers. What you're seeing is that the bounce broke, most likely during the latter part of yesterday's PM cycle. There are two factors involved. It can take up to 6 cycles for a bounce to clear and it can take the same amount of time for the depot to adjust to a dose change.

You need to give some thought to what numbers you're comfortable shooting. Ultimately, since you're following TR, you'll want to consider shooting low numbers. I'll shoot the full dose for any number above 50.
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Thanks for the reply. Tuxie had been on the increased dose for 7 cycles so I had given up on new dose wonkiness and bouncing as well since his numbers were pretty static until this morning.

I am not comfortable shooting around 50 since on an AT2 meter that would put him in the hypo range at about 36 on a human meter. Hypo watch using AlphaTrak readings starts at around 60. I have been told that anything 68 on AT2 meter or under calls for a reduction Once I am done with the strips I have I am going to look into getting a human meter since it is very confusing comparing my pet meter against human number protocols. I dropped the dose by .25 units this morning since I had no way to know how low he might have gone between +5 last night and AMPS. He is always higher in the morning. The insulin usually starts kicking in around +3 and his nadir is around +6-+7.
 
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Oops... You're right. With an AT2 the numbers are different. I was referring to a human meter since I was talking about Gabby and I use a human meter. The principle is the same, though. You would eventually work your way down to shooting any number that is above the cut-off for a dose reduction.

What you're describing as higher numbers in the morning could either be the usual effect of the insulin wearing off or it could be dawn effect. The latter is part of any animal's physiological cycle. Stress hormones increase in the early AM to help prepare us for the day. As a result, BG numbers also rise.
 
Sienne and Gabby said:
Oops... You're right. With an AT2 the numbers are different. I was referring to a human meter since I was talking about Gabby and I use a human meter. The principle is the same, though. You would eventually work your way down to shooting any number that is above the cut-off for a dose reduction.

What you're describing as higher numbers in the morning could either be the usual effect of the insulin wearing off or it could be dawn effect. The latter is part of any animal's physiological cycle. Stress hormones increase in the early AM to help prepare us for the day. As a result, BG numbers also rise.
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Thanks for your reply. Using an AT2 meter gets so confusing both for me and people replying to my posts.

Tuxie's numbers are always higher at AMPS than the evening before which is normal for him because of the overnight insulin wearing off and the dawn effect. He also rises for the first few hours after his breakfast and AM shot just in response to eating.

So to have his AMPS lower than his usual..especially with his static numbers over the last 3-4 days threw me a bit. Now at his +3 he is lower (or the same given 20% +/- error factor) than his AMPS. I was supposed to be out later this morning but I think I will hang around and see what happens. Tuxie doesn't often get a real active cycle but when he does he can do wonky numbers. Sometimes I have to go with gut feelings. Last night the advice was to increase his dose 1/2 unit, but I wanted to wait one more day and see how he went.

EDITED TO ADD: BTW His water and urination over the last 24hrs is about 1/2 what it has been and he showed zero on his urine glucose test this morning, so he must have kept under renal threshold all night.
 
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Today's numbers: ALPHA TRAK2 PET METER Nadir usually around 6-7 hours

AMPS 191 1/8c regular food
+1 242 small bit chicken
+2 232 1/8c regular food
+3 186 tsp regular food
+4 148 tsp regular food
+5 151 tsp regular food
+6 151 small bit chicken
+7 158 bone broth
+8 171 tsp food
+10 218 tsp food

Tuxie has been SO good about Mom poking his ears every hour. On the other hand this is a very thorough curve that was done today.
 
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tiffmaxee said:
I think your bottom line for shooting is 68. How do you feel about that?
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I think I would be comfortable with a bottom line more in the 85 range on an AT2 meter-that would be approximaetly 55 on a human meter . Around 70 on an AT2 meter(55 on a human meter) is where I start to watch for any signs of hypo. My target for Tuxie is to keep him in the blues for as much of the day as possible right now. I was told before that if Tuxie reaches a nadir of 68 on an AT2 meter it calls for a dose reduction.

Once I use up my strips and get a human meter(unfortunately no Relion in Canada) it should be easier doing reporting, since the calculating back and forth..both for me into mmol/l (which I understand) and into human meter terms can get confusing.
 
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tiffmaxee said:
Max's nickname is Mr. Unpredictable but it applies to many here, lol.
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I hear you there :) Just when I think I have a good handle on how Tuxie is going to react to doses, he throws a wrench into the works. At least today he has thrown a blue wrench so I can live with that one!! :)
 
and now next time.... you'll be ready to shoot that amps....

jazz_cat_by_if_not_for_gravity-d5p80qv.jpg
 
rhiannon and shadow said:
and now next time.... you'll be ready to shoot that amps....

jazz_cat_by_if_not_for_gravity-d5p80qv.jpg
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I hesitated at first this morning but still did the shot..just 1/4 dose less. At least I didn't panic...blue PS is NOT what I usually see with Tuxie!! Luckily today was not one of the days I had to go out first thing in the morning. The next 2 days I will be out within 4-5 hours after his Am shot (I do it at 4AM) so if it is low I will probably still get freaked out..lol
 
The nice thing about shooting this blue (albeit with a slightly smaller dose), is that you got to see how shooting lower can lead to a flatter cycle. :cool: That builds confidence for those days when you can't be around as much. If you have to head out the door 4-5 hours after his shot, you'll know what the cycle is looking like and you can load up an autofeeder (if you have one) with appropriate foods. And as Neko does, I see that this time Tuxie nadired a little earlier when starting lower. Although, that could have been because you shot a lower dose today.

You should be good going back to 5.75U tonight, and if fact you could probably go up to 6.0U. You've seen what 5.75 can do, and he only barely spent any time in normal numbers. The goal is to spend the majority of time in normal numbers and just a little extra juice will get him closer to that.

BTW, after a while you will crave blue preshots. One of the reasons I like shooting lower is that I know the cycle will be flatter and much easier to predict. If they start high, who knows if they will stay high or dive down.

I can't remember if I've given you the link to the Bravo meters before - cheapest in Canada, if you don't cross border shop like I do. That place is also cheaper place to buy other test strips, but Ebay is also where a lot of people in Canada shop for strips.
 
Wendy&Neko said:
The nice thing about shooting this blue (albeit with a slightly smaller dose), is that you got to see how shooting lower can lead to a flatter cycle. :cool: That builds confidence for those days when you can't be around as much. If you have to head out the door 4-5 hours after his shot, you'll know what the cycle is looking like and you can load up an autofeeder (if you have one) with appropriate foods. And as Neko does, I see that this time Tuxie nadired a little earlier when starting lower. Although, that could have been because you shot a lower dose today.

You should be good going back to 5.75U tonight, and if fact you could probably go up to 6.0U. You've seen what 5.75 can do, and he only barely spent any time in normal numbers. The goal is to spend the majority of time in normal numbers and just a little extra juice will get him closer to that.

BTW, after a while you will crave blue preshots. One of the reasons I like shooting lower is that I know the cycle will be flatter and much easier to predict. If they start high, who knows if they will stay high or dive down.

I can't remember if I've given you the link to the Bravo meters before - cheapest in Canada, if you don't cross border shop like I do. That place is also cheaper place to buy other test strips, but Ebay is also where a lot of people in Canada shop for strips.
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Wendy thanks for the link for the Bravo meter. I am going to see what Shoppers has in affordable strips. They give the meter for free so I don't really care about the cost of the meter...just the strips. I like to buy through Shoppers because of their reward points. I got $200 of strips free from saving up points so that made me very happy. Since in Canada we don't need a prescription for diabetic supplies they qualify for the 20% senior discount and points savings.

I may leave Tuxie's dose at the 5.5 units for 2 more days. I will be out during peak time tomorrow and Wednesday and even with leaving food I am sure I would be a nervous wreck if his cycle looked like it might be active. Worse comes to worse it puts Tuxie's protocol off by a few days but it will give me peace of mind ...I don't want any additional stress right now. :)
 
With Shoppers here, I find that everything costs a bit more than the other drug stores, so the savings I get back in reward points are just getting my money back. Oddly enough, the best price for diabetic supplies here is Safeway pharmacy, at least for syringes, lancets and insulin. London Drugs occasionally has sales on strips too.
 
Wendy&Neko said:
With Shoppers here, I find that everything costs a bit more than the other drug stores, so the savings I get back in reward points are just getting my money back. Oddly enough, the best price for diabetic supplies here is Safeway pharmacy, at least for syringes, lancets and insulin. London Drugs occasionally has sales on strips too.
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The interesting thing about Shopper's is that different stores within a close radius to each other can charge different prices on regular products. They have to have the same pricing on sale items but other than that prices flucuate between stores. The one closest to home has the best price on the strips of other Shopper's I have compared with. They are better than Walmart, Safeway and Rexall as well. I haven't priced London Drug since there is only one here and it is not in an area I usually go. So with the 20% senior discount and sometimes bonus $10 gift card on Thursdays it works out to be the best pricing that I have found so far. The needles and lancets are all pretty well the same regular price at different stores, but then with the 20% and the $10 gift card it is still a better deal for me.
 
Well now after a day of mostly nice blues Tuxie decided to get back into the red with a PMPS of 412. Not sure if this is a bounce or just short duration on the levemir. His +10 was 218 so he went up almost 200 points in 2 hours with no food involvement. Sigh...........
 
I'm late to the party, but wanted to comment on:
Tuxedo Mom said:
However this morning his AMPS shot was 191 (AlphaTrak meter) so something is going on.
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because I have an idea of what is going on! He's reached a dose where he's starting to see progress! That's a good thing!

I agree with Wendy that you could increase the dose without a problem, but I know that you're wanting to wait for your testing appointments to be done. Just wanted to mention though, that I think it's safe and the way to go when you're ready. It's highly likely that he'll bounce from today's long stretch of blues - which is why he's high at pmps. Reducing the dose will likely put him higher - it is the 5.75u dose that's getting him into the mid-100's.

One strategy that I found helped me was to observe the change from one test to the next, then calculate if punkin continued to drop at that rate, would he be under 50 (human meter) by the time he hit his nadir, which was typically around +5.5 unless he was clearing a bounce. That helped me know when to test next. Cats don't drop at a constant rate per hour - but it seems to me that typically the fastest drops are earlier in the cycle and once the drop rate slows, it doesn't *usually* speed back up. If a cat has a pattern of dropping later in the cycle, you can tell it from previous cycles. Tuxie doesn't regularly have that pattern.

So looking at today:

amps 191 +1 241 (increase of 50 points, reflects a spike from the carbs at breakfast)
+1/241 - +2/232 - drop of 9 points, essentially flat
+2/232 - +3/166 - drop of 66 points - Lev onset, food spike is over
+3/166 - +4/148 - drop of 18 points
+4/148 - +5/151 - increase of 3 points, essentially flat until +8/171 when he begins to rise

After +4 when his drop had slowed to 18 points, I think you could've stretched out your testing if you wanted to. In order for him to get below 68 after that, if he continued at 18 points/per hour, he'd have had to drop 80 more points (148-68 = 80) and at the rate of 18 points per hour, that would've taken him 5 hours (80/18 = 5hrs). At the +5 you can see that he's not dropping any more - he's hit the nadir of the cycle and while he might go down a few more points, he's not going to suddenly drop tons at that point.

Now I wouldn't take this as gospel, and no cat is going to follow this exactly, but I'm pointing it out because you're worried about leaving him. Being able to say "this is what MY cat is MOST likely to do" helps you figure out when to test next, when you can go out, when you can sleep, etc. Michelle/Mannie pointed it out to me and it helped me a lot.

Thanks for clarifying about the acro test in yesterday's condo. A 68 is negative, and that it was done by MSU says that it was accurate. You might want to add a "labs" tab onto his spreadsheet and record labs like this there. If you look at the bottom where it has US and World tabs, there should be a + symbol, and that adds another page. That can be really helpful to put labs in there. Marje added that on to the more recent master for the spreadsheets.

I think you'll be happy with a human meter when you run out of AT strips. Everything will be a little bit easier.

Hope all goes well for you tomorrow. I'll be thinking of you! :bighug: Let us know how what you learn.
 
julie & punkin (ga) said:
I'm late to the party, but wanted to comment on:


because I have an idea of what is going on! He's reached a dose where he's starting to see progress! That's a good thing!

I agree with Wendy that you could increase the dose without a problem, but I know that you're wanting to wait for your testing appointments to be done. Just wanted to mention though, that I think it's safe and the way to go when you're ready. It's highly likely that he'll bounce from today's long stretch of blues - which is why he's high at pmps. Reducing the dose will likely put him higher - it is the 5.75u dose that's getting him into the mid-100's.

One strategy that I found helped me was to observe the change from one test to the next, then calculate if punkin continued to drop at that rate, would he be under 50 (human meter) by the time he hit his nadir, which was typically around +5.5 unless he was clearing a bounce. That helped me know when to test next. Cats don't drop at a constant rate per hour - but it seems to me that typically the fastest drops are earlier in the cycle and once the drop rate slows, it doesn't *usually* speed back up. If a cat has a pattern of dropping later in the cycle, you can tell it from previous cycles. Tuxie doesn't regularly have that pattern.

So looking at today:

amps 191 +1 241 (increase of 50 points, reflects a spike from the carbs at breakfast)
+1/241 - +2/232 - drop of 9 points, essentially flat
+2/232 - +3/166 - drop of 66 points - Lev onset, food spike is over
+3/166 - +4/148 - drop of 18 points
+4/148 - +5/151 - increase of 3 points, essentially flat until +8/171 when he begins to rise

After +4 when his drop had slowed to 18 points, I think you could've stretched out your testing if you wanted to. In order for him to get below 68 after that, if he continued at 18 points/per hour, he'd have had to drop 80 more points (148-68 = 80) and at the rate of 18 points per hour, that would've taken him 5 hours (80/18 = 5hrs). At the +5 you can see that he's not dropping any more - he's hit the nadir of the cycle and while he might go down a few more points, he's not going to suddenly drop tons at that point.

Now I wouldn't take this as gospel, and no cat is going to follow this exactly, but I'm pointing it out because you're worried about leaving him. Being able to say "this is what MY cat is MOST likely to do" helps you figure out when to test next, when you can go out, when you can sleep, etc. Michelle/Mannie pointed it out to me and it helped me a lot.

Thanks for clarifying about the acro test in yesterday's condo. A 68 is negative, and that it was done by MSU says that it was accurate. You might want to add a "labs" tab onto his spreadsheet and record labs like this there. If you look at the bottom where it has US and World tabs, there should be a + symbol, and that adds another page. That can be really helpful to put labs in there. Marje added that on to the more recent master for the spreadsheets.

I think you'll be happy with a human meter when you run out of AT strips. Everything will be a little bit easier.

Hope all goes well for you tomorrow. I'll be thinking of you! :bighug: Let us know how what you learn.
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Thank you so much for your analysis of the situation. I really appreciate information that I can use to make sense of what is happening.

I did however feed Tuxie little bits of food every hour after testing. I know it was not a lot but he does do food spikes even on low carb. I wonder if I hadn't have fed him where his numbers might have gone. Of course there is no way he would ever allow that..lol.

I am a bit spreadsheet challenged so I will create a blank one and play with it. I am scared of doing something on my current one and messing the whole thing up. And since I need the one with world and US I don't know if the newer master has that option?? I actually wanted to do an information sheet but I had so much trouble getting the spreadsheet created and shared that I gave up.

I don't see my doctor until Wednesday. I had another appointment tomorrow that I will be out for about 5 hours..right in the active times of Tuxie's cycles. Wednesday I am seeing the new Dr. but one I know because I have been taking my older neighbour to her for the last 2 years. I like her and she is good and actually cares about her patients. Most likely it will just be a catch up appointment and some blood work, but at least that will get things started. In the meantime I am trying very hard to stay calm and not get freaked out over anything. I even got 6 hours sleep last night!!!! YAH for me!!! So for the next couple of days I will probably stay with the 5.5 units and then go to 6 when I can be around for testing.
 
I'm not suggesting that you replace your current spreadsheet, just add a tab. If you don't want to play with your current one, I could add it for you, or marje also would. You'd need to pm one of us your sign-in information but it would just take a couple of minutes to fix it for you.

Technology is a mixed blessing, isn't it? Helps so much but it can be so confusing!

Sounds like you've got a good plan for the next few days.
 
julie & punkin (ga) said:
I'm not suggesting that you replace your current spreadsheet, just add a tab. If you don't want to play with your current one, I could add it for you, or marje also would. You'd need to pm one of us your sign-in information but it would just take a couple of minutes to fix it for you.

Technology is a mixed blessing, isn't it? Helps so much but it can be so confusing!

Sounds like you've got a good plan for the next few days.
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I will work on the spreadsheet in a couple of days. If I can't get the extra tab figured out I will let you know..thanks!!!

BTW..Tuxie threw me another blue this evening at +3.5...158. But this was obviously an error since his +5 was 370. Well maybe another early evening for me. Fingers crossed for a decent AMPS but not too low so I won't have to worry when I am out. :)
 
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