5/14 Tuxie AMPS-472;+5-214:+6-182:+8-79:+8.5-90:+10-65

[Tuxedo Mom]

USING ALPHATRAK 2 PET METER

I haven't posted Tuxie's condos in over a week or so since there was nothing unusual or interesting about them. He had a dose increase in PM on May8 to 6.0 units. I hold his dose 5 days since it can take that long to show results with him. On May 13 he hit a nadir of 53, (which would be approximately 37 on a human meter) so I did a dose decrease of .5 units down to 5.50 units.

Today he has hit a nadir of 65, (which would be approximately 45 on a human meter) at +10, which for pet meters calls for a reduction. I gave him a tsp MC 18% at +7, +8 and +8.5 and then HC 38% at +10. This is the same pattern he followed on May 13, with his nadir coming much later in the cycle even with giving MC 10% food during the drop. Of course I am totally expecting a big bounce in the next cycle or two.

With his numbers now being out of his normal pattern it makes it very hard for me to plan time away from home and I have some commitments this weekend...I need to go to my son's place twice a day and feed my grandkitties....so I will be away 3 hours twice a day. Also I would really like to be able to attend a BBQ I was invited to. Until the last few days I could pretty well judge his nadir time as around +6 and not worry about it until shot time.

So my question is...should I do a full .5 unit decrease (protocol calls for a reduction on a pet meter at 68) ??

 

[Marje and Gracie]

Mary Ann

Normally the reduction would be 0.25u. A higher dose, once reduced, can affect the depot for up to six subsequent cycles. It's possible with a depot as large as 6u, you could still be seeing some depot action but because you have to be away, it's best to be a little more conservative and reduce tonight (unless he zooms up and bounces; in that event, you could shoot through the bounce tonight with 5.5u and reduce in the morning). You can always go back up if the reduction fails.

Because he's on levemir, he typically would not nadir at +6 so if he does, he's not getting the duration he should with this insulin. This is further evidenced by him going from 112 to 211 in one hour on May 12. That definitely looks like lack of duration to me which we call "big insulin poop out".

If you are more comfortable reducing again by 0.5u, given your schedule, you can. The protocol would call for a 0.25u but you have to factor in your schedule and comfort level.

 

[Tuxedo Mom]

Mary Ann

Normally the reduction would be 0.25u. A higher dose, once reduced, can affect the depot for up to six subsequent cycles. It's possible with a depot as large as 6u, you could still be seeing some depot action but because you have to be away, it's best to be a little more conservative and reduce tonight (unless he zooms up and bounces; in that event, you could shoot through the bounce tonight with 5.5u and reduce in the morning). You can always go back up if the reduction fails.

Because he's on levemir, he typically would not nadir at +6 so if he does, he's not getting the duration he should with this insulin. This is further evidenced by him going from 112 to 211 in one hour on May 12. That definitely looks like lack of duration to me which we call "big insulin poop out".

If you are more comfortable reducing again by 0.5u, given your schedule, you can. The protocol would call for a 0.25u but you have to factor in your schedule and comfort level.

Thanks for the reply. I have been suspecting that he does not have as good a duration with the Levemir as I would like. However when he was originally on Lantus for the first couple of months it did very little for his high numbers even with a slow steady increase.

His +11 is 162 after having had high carb 38% food at +10. I will be testing him for his PMPS in about 1/2 hour so considering his reactions the last few days and the fact that I will be away for periods of time this weekend (3 day..long weekend) and the fact that his nadir right now is coming later than usual, I think I would be more comfortable with taking the .5 unit reduction. I actually had taken a .5 unit reduction 2 days ago and he is still hitting lower numbers so hopefully this will not throw his numbers out too much.

 

[Marje and Gracie]

Certainly your decision but I'm going to take an opportunity for a teaching lesson It doesn't apply to today but let's look at 5/12 since I already gave it as an example of lack of duration.

High carbs can affect the duration. Unless kitty is running low (and 76 on the AT is not low), you don't typically want to feed at or after nadir. Think of the action of the insulin as a car. If you are coming up to a stop sign, if you just take your foot off the accelerator, the car will glide to the stop sign. But if you slam on the brake (i.e. feed), then you won't make it to the stop sign. You decrease the duration at a time when it is likely waning anyway. That might have been a good time to experiment and see if he would surf for you without food to extend his duration.

Having said that, we all have to experiment and see what works best and when with our kitties. Sometimes it changes depending on the dose, where they are in the cycle, etc. Sometimes, I've experimented with getting Gracie to surf after she was flat, only to have her drop on me. It's all about learning about your kitty.

You're doing great!! Good luck with the reduction.

 

[Tuxedo Mom]

IF I could just be at home the nest few days and not worry about sleeping I may have taken a different approach. However that is not the way it is...Murphy's Law...So I went with the .5 unit reduction tonight. Tuxie had a PMPS of 214, which for HIM is on the lower side for a preshot.


When Tuxie was hitting the green numbers today and two days ago I could have told you from the way he was acting. He was absolutely starving and very vocal about it. I had planned on having a lax test day today, but when he chased me all over the house meowing loudly I figured something was up with his numbers ...or should I say DOWN.. . He continued with the food beg until just after his +11 test. Some of my reasoning is just knowing how Tuxie normally acts and reacts. I have experienced hypos myself before and the need to eat is one of the main signs I noticed.

Fingers and paws crossed that the reduction was the right choice.

 

[julie & punkin (ga)]

The only thing I would add to your discussion is that because these green numbers today were only 4 cycles after the last reduction, it's possible that the depot from the 6.0u dose is still helping with controlling his blood sugar and it may have contributed to the 65 today. Going down 1u in 5 cycles is a very large decrease. So I'd just be watchful and if his blood sugar trends upward and you don't see him back in green numbers in the next day or so, I'd return to 5.5u so you don't lose momentum. Anytime a cat sits in high numbers for very long that can cause glucose toxicity and the need to then increase the dose ever higher to get back on top of the blood sugar again.

I wouldn't change what you decided to do. I'm just suggesting you watch in the next cycles and see how he does, in case it's too much of a decrease too quickly, and therefore a failed reduction.

You might want to update your subject line since you've resolved the question about his dose and how much to reduce for tonight.

I hope you have a wonderful weekend and get to enjoy all the extras you've got planned!!!

 

[Tuxedo Mom]

The only thing I would add to your discussion is that because these green numbers today were only 4 cycles after the last reduction, it's possible that the depot from the 6.0u dose is still helping with controlling his blood sugar and it may have contributed to the 65 today. Going down 1u in 5 cycles is a very large decrease. So I'd just be watchful and if his blood sugar trends upward and you don't see him back in green numbers in the next day or so, I'd return to 5.5u so you don't lose momentum. Anytime a cat sits in high numbers for very long that can cause glucose toxicity and the need to then increase the dose ever higher to get back on top of the blood sugar again.

I wouldn't change what you decided to do. I'm just suggesting you watch in the next cycles and see how he does, in case it's too much of a decrease too quickly, and therefore a failed reduction.

You might want to update your subject line since you've resolved the question about his dose and how much to reduce for tonight.

I hope you have a wonderful weekend and get to enjoy all the extras you've got planned!!!

Thanks for your input Julie

I still question doing the second reduction so soon, but when Tuxie goes that low that quickly he tends to really bounce back to the high numbers. It seems that every time he is at 6 units he starts hitting the lower (for him) greens and then bounces. Since I will have times I am not around to test on an on-going basis, I would feel more comfortable if his dose is not in a worrisome range. His regular home made food is about 3% carbs. On Wednesday and today I gave him 18% and 38% carbs which did not put his numbers way back up. Plus with him having a different nadir time the last few days I don't know what is a "safe" time to be away for a number of hours. As much as I want to get him into the blues (my target is low blues on the AT meter) on an ongoing basis, I don't want to have him hitting greens and falling when I can't be here to monitor him.

I will definitely put him back to the 5.5 dose if his numbers go back up and stay there...as long as it doesn't appear to be a bounce, which I am totally expecting.

Edited to add: Tuxie's +4 PM is 83 so the cycle is still active.

I changed the subject line...thanks for reminding me

 

[Marje and Gracie]

Haha...I did mention in my first response that this could be depot from the 6u dose . But given Mary Ann's commitments, I thought it safer to reduce and go back up if necessary.