? 5/24 Tuxie AMPS-194; +1/2-250; +1-232 +2-200;+3-151; +4-112;+5 -94 PMPS-369 ..different approach

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Tuxedo Mom

Tuxedo Mom

Member Since 2014
ALPHA TRAK 2 PET METER

Yesterday:
http://www.felinediabetes.com/FDMB/...-283-9-383-pmps-436-2-490-4-416-6-364.138294/

RECAP:
AMPS 419; +2-430;+5.5 -239;+7-283: +9-383:
PMPS-436;+2-490;+4-416; +6-364

Today was supposed to be a dose increase but Tuxie threw me a curve. His morning BG was 194 (I did 3 tests to be sure...poor Tuxie), so he must have gone lower in the 6 hours between the last PM test and his AMPS test. I waited 15 minutes and retested and the numbers were the same. I gave him a Tbsp of reg food and retested at +1/2 (15 minutes after food) and he was 250 so I gave him the old dose of 5.5 units. He was actually 1/2 hour late for his test and his shot is now 1 hour late from regular times.

So was this the right thing to do??


 
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His numbers clearly came down last night. One thing to consider based on your testing this morning is that the numbers were not still dropping. While this is complete 20/20 hindsight, you would have been OK increasing. Many people are uncomfortable increasing if numbers are dropping. In this case, though, Tuxie was surfing. It's OK to not have increased. I just wanted you to know your options.
 
Sienne and Gabby said:
His numbers clearly came down last night. One thing to consider based on your testing this morning is that the numbers were not still dropping. While this is complete 20/20 hindsight, you would have been OK increasing. Many people are uncomfortable increasing if numbers are dropping. In this case, though, Tuxie was surfing. It's OK to not have increased. I just wanted you to know your options.
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Thanks for the reply. I did a +1 test so the food should be kicking in and he is basically the same as he was at +1/2...a little lower but within the error factor.

Sometimes Tuxie will take up to 5 days to react to a dose increase or decrease so I really hesitated doing the increase this morning. Also I had given him a Tbsp food 15 minutes before the second test, so I don't know if that was affecting his readings. He started LOUDLY demanding food about 2 hours before test time. I will continue testing through the day.
 
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You know your cat! If you want to give him the extra time for the dose, that's fine. If you opt to hold the dose, you could always shoot an hour early this evening to get back on schedule.
 
Sienne and Gabby said:
You know your cat! If you want to give him the extra time for the dose, that's fine. If you opt to hold the dose, you could always shoot an hour early this evening to get back on schedule.
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Thanks again..depending how his numbers go I will most likely shoot early tonight to get back on schedulte
 
Update on today: I am trying to "feed" the lower numbers to keep him from going too low and either bouncing or earning a reduction. I want him to get used to lower numbers without the huge bounce he usually does. Insulin onset is usually around +3 with nadir "usually" ranging from +6-+9

AMPS 194 waited 15 minutes retested same reading gave tbsp reg food
+1/2 250 (15 minutes after food) gave tbsp reg
+1 232 tbsp reg
+2 200 tsp reg food small drop syrup
 
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Mary Ann:

I wouldn't feed HC with numbers that aren't green. Using LC should encourage a surf. If you encourage Tuxie to stay in yellows, my best guess is that you're going to encourage glucose toxicity. (This sounds worse that it is.) What this means is that his body treats the higher numbers as his new "normal." The consequence is that it's harder to get him out of those numbers and you may ultimately make the bouncing worse.

I think your strategy is on target. You just need to lower the range where you're intervening. Think about wanting blue pre-shots and blue or green numbers overall. The additional benefit of this range is that you'll be keeping Tuxie under renal threshold.

 
Sienne and Gabby said:
Mary Ann:

I wouldn't feed HC with numbers that aren't green. Using LC should encourage a surf. If you encourage Tuxie to stay in yellows, my best guess is that you're going to encourage glucose toxicity. (This sounds worse that it is.) What this means is that his body treats the higher numbers as his new "normal." The consequence is that it's harder to get him out of those numbers and you may ultimately make the bouncing worse.

I think your strategy is on target. You just need to lower the range where you're intervening. Think about wanting blue pre-shots and blue or green numbers overall. The additional benefit of this range is that you'll be keeping Tuxie under renal threshold.
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With Tuxie using an AT2 meter once he gets to greens he is approaching hypo numbers. Because the AT reads about 35% higher than a human meter my target is to keep him in the lower blues. I am not using HC food unless he goes very low. I used a teeny drop of syrup to keep him from doing any major drops.
 
Further update: USING AT2 PET METER so readings are about 35% higher than a human meter:

AMPS 194 waited 15 minutes retested same reading gave tbsp reg food
+1/2 250 (15 minutes after food) gave tbsp reg
+1 232 tbsp reg
+2 200 tsp reg food small drop syrup
+3 151 tsp MC small drop of syrup
 
There is no harm in maintaining the dose a little longer if you think Tuxie hasn't gotten use to the dose yet. The protocol is a suggestion not a LAW! As we all know ECID, and every bean is different also, so you have to do what you feel comfortable with.

I use a human meter, and I am always confused when I look at a spreadsheet that uses the AlphaTrax. I wish there were someway to change the spreadsheet so it was easier to understand for those of use who use the human meters.

If you goal is remission, I do agree with Sienne, I don't think you should be giving HC, gravy or syrup when Tuxie is near 200. If anything maybe give him a higher low carb food. For instance, last night Sammy started out lower than normal on his PMPS so I added a bit of 8% carb food in with his 4-5% food, it was only about â…“ of the mix. But this way it gave him a few more carbs but didn't abort the cycle, which is I think what you might be doing by giving syrup when he doesn't need it. When he nears 100 you can always start going for the medium carb food if you are really nervous, but if at all possible I would try to hold off on MC, HC, gravy or syrup until he is getting in to the GREEN, and nearing those potentially Hypo numbers.

That is just my opinion, like I already mentioned, bottom line, you need to do what you feel comfortable with.
 
Tina & Sammy said:
There is no harm in maintaining the dose a little longer if you think Tuxie hasn't gotten use to the dose yet. The protocol is a suggestion not a LAW! As we all know ECID, and every bean is different also, so you have to do what you feel comfortable with.

I use a human meter, and I am always confused when I look at a spreadsheet that uses the AlphaTrax. I wish there were someway to change the spreadsheet so it was easier to understand for those of use who use the human meters.

If you goal is remission, I do agree with Sienne, I don't think you should be giving HC, gravy or syrup when Tuxie is near 200. If anything maybe give him a higher low carb food. For instance, last night Sammy started out lower than normal on his PMPS so I added a bit of 8% carb food in with his 4-5% food, it was only about â…“ of the mix. But this way it gave him a few more carbs but didn't abort the cycle, which is I think what you might be doing by giving syrup when he doesn't need it. When he nears 100 you can always start going for the medium carb food if you are really nervous, but if at all possible I would try to hold off on MC, HC, gravy or syrup until he is getting in to the GREEN, and nearing those potentially Hypo numbers.

That is just my opinion, like I already mentioned, bottom line, you need to do what you feel comfortable with.
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The pet meters read about 25% higher than a human. So a reading of say 100 on a pet meter would be about 65 on a human, So Tuxie's 200 is about 130 on a human. The dose reduction point for a pet meter is at 68 (pet meter reading) rather than 50 (human meter reading)


It was suggested a few days ago to try to hold numbers using LC,MC ,HC and syrup deoending on his numbers. This is being done by another pet parent and she has had decent success with keeping Sheba from major bounces and preventing decreases while she gets used to being in lower numbers. Here is her SS

https://docs.google.com/spreadsheets/d/1fiN54cqJJwGCaoo8aB0OytAsVZn6LSKGYX3fyRTJdMc/pubhtml
 
I think it is good that you are trying something different and off the reservation. I am always looking for new ways to treat FD. My motto is to keep trying different things until you find what works for you and your cat. I will be interested to see if this method is successful. I looked at Sheba's spreadsheet her numbers are getting better, but her insulin is also still being increased. I don't know if it is coincidence or if it is the method in which Bron is using to slow the drops and help prevent bounces.
 
Tina & Sammy said:
I think it is good that you are trying something different and off the reservation. I am always looking for new ways to treat FD. My motto is to keep trying different things until you find what works for you and your cat. I will be interested to see if this method is successful. I looked at Sheba's spreadsheet her numbers are getting better, but her insulin is also still being increased. I don't know if it is coincidence or if it is the method in which Bron is using to slow the drops and help prevent bounces.
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I don't know if this approach will work in the long run. With Sheba's ss she has increased but she has also held the 6.75 unit dose for 12 days. What I would like to see is Tuxie getting into lower numbers without doing the huge bounces he is so good at. The big swings from high to low are very hard on the body. Even if he were to stay in low yellows and have a flat curve I would prefer that to bouncing from green to black. Then I can always increase his dose if he stabilizes in yellow, and a flat yellow is much better than the big bounces. I would, of course, like to get him in remission, but if all I end up with is a regular healthy range ( low blues) then I would be happy with that. I want to keep him in a range where there is very little damage happening to his organs.
 
Tuxedo Mom said:
I don't know if this approach will work in the long run. With Sheba's ss she has increased but she has also held the 6.75 unit dose for 12 days. What I would like to see is Tuxie getting into lower numbers without doing the huge bounces he is so good at. The big swings from high to low are very hard on the body. Even if he were to stay in low yellows and have a flat curve I would prefer that to bouncing from green to black. Then I can always increase his dose if he stabilizes in yellow, and a flat yellow is much better than the big bounces. I would, of course, like to get him in remission, but if all I end up with is a regular healthy range ( low blues) then I would be happy with that. I want to keep him in a range where there is very little damage happening to his organs.
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I totally understand that!
 
Further update:

USING AT2 PET METER so readings are about 35% higher than a human meter:

AMPS 194 waited 15 minutes retested same reading gave tbsp reg food
+1/2 250 (15 minutes after food) gave tbsp reg
+1 232 ( 45 minutes after food) tbsp reg
+2 200 tsp reg food small drop syrup
+3 151 tsp MC 10% small drop of syrup
+4 112 tsp MC 14% tsp reg drop syrup

Nadir usually around +6-+8 hours so I will continue to monitor and "feed the blues"
 
I had to feed Max to prevent reductions for a long, long, time. I used mc food rather than hc or karo unless he got close to 5o which would be 68 for you. If I still felt he was close to a reduction then I used the higher carbs. It takes practice to see what works for your cat. I found Max would jump up too high on the hc or karo. Good luck experimenting. It seems to me like holding would be a good idea and shooting a little early, maybe half hour tonight and half hour tomorrow morning depending on what the numbers are. Good luck.
 
tiffmaxee said:
I had to feed Max to prevent reductions for a long, long, time. I used mc food rather than hc or karo unless he got close to 5o which would be 68 for you. If I still felt he was close to a reduction then I used the higher carbs. It takes practice to see what works for your cat. I found Max would jump up too high on the hc or karo. Good luck experimenting. It seems to me like holding would be a good idea and shooting a little early, maybe half hour tonight and half hour tomorrow morning depending on what the numbers are. Good luck.
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Thanks for the information. The syrup I have used so far is a teeny drop in his food and from what I am seeing it is not causing any long term spike. I will definitely not use syrup once he hits +6 or so since he should be at or close to nadir. I would be so happy to have him surf where he is, but I know better than to expect that, since Tuxie calls his own shots. :arghh:

I don't want a reduction, just a settling in to lower numbers without big bounces. As I said I can always increase once he settles down and picks a colour to stay in (hopefully blues or even low yellow) Considering Tuxie likes to play with blacks and reds, I would be quite happy with that. My plan is to shoot early tonight as long as his numbers don't go totally wonky.
 
The other thing you need to take into account is how your cat reacts to the higher carbs and the syrup. I have learned that Skooter is a wee bit carb sensitive, so even a MC can make him spike and even a drop of syrup can make him go sky high......I do have to agree though, the syrup and HC should be for "special occasions" only.....which for me is when he gets near that hypo territory, and as you have stated that would be around a 68 on the AT. Skooter normally nadirs around +2 or +3 ....which I feel a little bit "lucky for because I can tell fairly early in the cycle what he is going to do....NORMALLY....but again, Skooter IS a cat, so he makes his own rules lol
 
MollynSkooter said:
The other thing you need to take into account is how your cat reacts to the higher carbs and the syrup. I have learned that Skooter is a wee bit carb sensitive, so even a MC can make him spike and even a drop of syrup can make him go sky high......I do have to agree though, the syrup and HC should be for "special occasions" only.....which for me is when he gets near that hypo territory, and as you have stated that would be around a 68 on the AT. Skooter normally nadirs around +2 or +3 ....which I feel a little bit "lucky for because I can tell fairly early in the cycle what he is going to do....NORMALLY....but again, Skooter IS a cat, so he makes his own rules lol
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I used HC and syrup (way more than today) when Tuxie was hitting hypo numbers and although it did bring him up it was not by a lot and not for long. I am not trying to treat a hypo today, just keep him from going into the greens in order to keep him from earning a reduction. This is a different approach that will let him get accustomed to lower (for him) numbers without doing the bounces he always does when he hits greens. Since he started lower than usual today, this was a good chance to see if this approach would help. As I posted earlier in this thread, it was a something that Sheba's Mom was trying and it was suggested that maybe I could also try it. I don't know whether it will help, but at least it can't hurt considering the big bounces Tuxie is so good at when he hits the greens.
 
+5 hour update..still dropping a bit

USING AT2 PET METER so readings are about 35% higher than a human meter:

AMPS 194 waited 15 minutes retested same reading gave tbsp reg food
+1/2 250 (15 minutes after food) gave tbsp reg
+1 232 ( 45 minutes after food) tbsp reg
+2 200 tsp reg food small drop syrup
+3 151 tsp MC 10% small drop of syrup
+4 112 tsp MC 14% tsp reg drop syrup
+5 94 tsp MC 14% tsp reg food NO syrup

Unfortunately he hit the greens in spite of MC food and syrup so most likely he will do a big bounce later. I wonder how low he would have gone without the MC and syrup??
 
Just an FYI, the difference between an AT and human meter isn' a consistent 35%. A reduction is indicated at 68 on an AT. The difference at the lower end is less than at the higher end at the higher end, it's far less important. At one point, we thought the difference was consistently 30 points. Strip technology has been changing and as a result, there's less of a gap between the two kinds of meters.

You're doing a great job!

 
Sienne and Gabby said:
Just an FYI, the difference between an AT and human meter isn' a consistent 35%. A reduction is indicated at 68 on an AT. The difference at the lower end is less than at the higher end at the higher end, it's far less important. At one point, we thought the difference was consistently 30 points. Strip technology has been changing and as a result, there's less of a gap between the two kinds of meters.

You're doing a great job!
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Thanks for the encouragement!

I go by the % difference using 35% as a base. If you take a human meter reading of 50 and add 35% to it it comes to 68 on a pet meter. So I don't go by the points, rather by the % difference. The difference will be larger with higher numbers since the numbers themselves are higher and lower number will be closer since the % difference gives less of a spread...if that makes sense??

EX. Human 50 AT 68 18 point difference
Human 100 AT 135 35 point difference
Human 200 AT 270 70 point difference

I have done comparisons with my AT2 pet meter and the FreeStyle Lite human meter and regardless of whether the numbers are high or low there is pretty well a consistent 35% difference between the two. I don't use the FS Lite for my every day readings since I have become climatized to understanding (for myself) the At2 readings.
 
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Update...Tuxie is holding steady so I can go outside and do some yard work now :)

USING AT2 PET METER so readings are about 35% higher than a human meter:

AMPS 194 waited 15 minutes retested same reading gave tbsp reg food
+1/2 250 (15 minutes after food) gave tbsp reg
+1 232 ( 45 minutes after food) tbsp reg
+2 200 tsp reg food small drop syrup
+3 151 tsp MC 10% small drop of syrup
+4 112 tsp MC 14% tsp reg drop syrup
+5 94 tsp MC 14% tsp reg food NO syrup
+6 97 Tbsp reg food
 
Fantastic cycle today! :D Paws crossed it's the first of many like this. :):) I do like seeing that little touch of green there. I personally would prefer that to a cycle of flat yellow.

One of my favorite quotes here is from a Think Tank forum thread by Steve and Jock (first ever kitty user on Levemir), referring to a post by Kirsten (Roomp of Rand and Roomp):
I'm most interested in Kirsten's reply, because she brings up an important related issue -- that it's much easier (with Levemir or Lantus) to maintain a cat in euglycemic ranges (say, 75-160 or so), than to maintain them at some randomly chosen range that scares some people less. Blood sugar simply seems to get more stable (in the non-complicated kitties) when you keep it near normal.

So it's not at all a matter of tug-of-war between overdosing and underdosing. It's a matter of overcoming fear of the 'normal' blood sugar ranges, because those are the stable ones. People who see "68" and panic and lower the dose next time are doing themselves no favour, because it's way harder for most diabetic cats to get regulated between 150-250 than it is between 75-150, but you won't know this until you try. This is, as Kirsten says, because hyperglycemia stresses the pancreas and makes regulation hard.
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I've tried it and it's true for Neko. A dose with a nadir in the 70's (human meter) means much flatter cycles for her. You'll have to experiment and see what range works for Tuxie. Of note, this "rule for Neko" was something I discoverd a couple of years ago when her SS was much more, umm, colourful. :p:p
 
Wendy&Neko said:
Fantastic cycle today! :D Paws crossed it's the first of many like this. :):) I do like seeing that little touch of green there. I personally would prefer that to a cycle of flat yellow.
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Thank you. Tuxie surprised me with a blue AMPS today so I decided to try "feeding the blues". It may work it may not but today was a good day to try. I totally agree I would rather have him in the blues all the time, but I would rather see him nicely planted in the yellows than running between green and black. Yellow is NOT my fabourite colour, but better that than huge bounces. I am definitely getting better prepared to shoot low numbers as they come.

At least I didn't panic at his lower PS this morning and cut his dose in half...which I would have done (and did) a month or so ago. For Tuxie it was a low PS but I carried on with his usual dose so although I don't get the "balls of steel" I should get a gold star :D
 
Well Tuxie's PMPS was way up to 369 in spite of me trying to keep him from going low during the day cycle. He was 1 hour late this morning for his shot and I have shot 1 hour early for the PM shot. So he did a shoot of 13/11 for today. The last few hours of his cycle really show big jumps. Maybe I will consider a R for early cycle.
 
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I wouldn't jump to using R. Let's keep an eye on Tuxie's cycles. Overall, you're routinely seeing lower numbers. While a judicious use of R can be very helpful, it's also been known to cause more bouncing.
 
Sienne and Gabby said:
I wouldn't jump to using R. Let's keep an eye on Tuxie's cycles. Overall, you're routinely seeing lower numbers. While a judicious use of R can be very helpful, it's also been known to cause more bouncing.
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I am not planning on trying R right away. But I have wondered about Levemir duration times for quite awhile now and it is something that is brewing on the back burner for the future. I will continue with the route I am on for the time being :)
 
What is R? I have seen other talk about that too but can't find any thing in that says what it is. Thanks
 
At this point I'd continue to try the approach you are using now, and wait another day or so. If you are confident at being able to manage lower numbers, If it were me, I'd still do the dose increase if you don't see any more green in the next day or two.
 
Meya14 said:
At this point I'd continue to try the approach you are using now, and wait another day or so. If you are confident at being able to manage lower numbers, If it were me, I'd still do the dose increase if you don't see any more green in the next day or two.
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Thanks Meya I was thinking the same. I have found out that I can manage the lower numbers with food (if he hits them again). The morning "experiment" worked out fine, but Tuxie is Tuxie and decided to go back into higher numbers for the evening. I will give him one more day then do an increase if his numbers are still running higher.
 
I'd be remiss if I didn't mention that cats bounce until they don't. Sometimes, there's absolutely nothing you can do that will stop cat from bouncing. That doesn't mean you shouldn't try, though. I wouldn't want you to get frustrated or think you were doing something wrong or weren't doing enough.
 
Sienne and Gabby said:
'd be remiss if I didn't mention that cats bounce until they don't. Sometimes, there's absolutely nothing you can do that will stop cat from bouncing. That doesn't mean you shouldn't try, though. I wouldn't want you to get frustrated or think you were doing something wrong or weren't doing enough.
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Thank you. I do understand that a cat will do what a cat will do. I do get frustrated but it doesn't stop me from carrying on. At least Tuxie's bounce was not as bad as they have been sometimes when he hits the greens. Rather than hitting high red or black he started off in the pink today.
 
ewalker: R is regular insulin. It has an onset of about 30minutes-1hr and lasts about 6-8 hours in people, probably a little shorter in cats. R insulin is used with some caregivers in addition to long acting insulin to knock down high numbers. R insulin has a higher incidence for hypo events, and therefore it's somewhat of a last resort, and only a consideration if a caregiver is monitoring closely, and can handle if a hypo event happens.
 
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