? 3/9 TiTi BG 29@ +5.5 sheesh!

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This was entirely unexpected. 29 - She's never been so low! I got some HC into her (FF with 2 drops of homey added), and will check her soon.
She's acting entirely normal, but 29?????
 
Did you retest to make sure the test was valid?

Test every 20 minutes when she is that low. I guess she want a whole unit reduction this time. You might also consider a one time reduced dose tonight to drain the depot. It is waaaaaaay too full.

Up Titi, up please sweetie. :eek:
 
Wendy&Neko said:
Did you retest to make sure the test was valid?

Test every 20 minutes when she is that low. I guess she want a whole unit reduction this time. You might also consider a one time reduced dose tonight to drain the depot. It is waaaaaaay too full.

Up Titi, up please sweetie. :eek:
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I didn't retest, but judging by the 71, the 29 was correct. Fortunately, TiTi is always hungry, and comes up very fast.

I wonder if she's trying to regain her 7Unit dose?
 
I think you can wait until PMPS to make the decision. If she's starting to rise quickly (bounce) then you might be OK going to the new reduced dose. But if she's still low, I might take a bit off the dose, maybe a few units, to help drain the depot. I just don't like having a depot around that gets a cat to the 20's. :eek:
 
It took some experimenting for me to figure out the right BCS for Jack. I had a few similar BCS / depot draining shots that really shot him up.

These days a 2/3 to 3/4 of a normal dose are what I shoot for, anything less and like TiTi he heads for the rafters.
 
Wendy&Neko said:
I think you can wait until PMPS to make the decision. If she's starting to rise quickly (bounce) then you might be OK going to the new reduced dose. But if she's still low, I might take a bit off the dose, maybe a few units, to help drain the depot. I just don't like having a depot around that gets a cat to the 20's. :eek:
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An hour before shot time, TiTi is at 81. What I am seeing is a very flat TiTi.

It was 29, and that could mean she was around 33.
It could mean she was around 25.
BUT
She was absolutely normal and perky, so I figure she was not in the mid twenties, more likely the 30s.

I think this was bean error. I fed her at AMPS, and then went to work - working from home today.
I fed her again at +2
I did not feed her again until +6.
If I had fed her at +3 or +4 and/or +5, she might not have fallen so low.

I am wondering if her falling numbers indicate a return to a much lower number in the near future.
Her pancreatitis is controlled now, and I am feeding her half of what I was feeding her when her numbers rose so high.

I'm reluctant to interfere with what seems to be a very healthy trend.

So, here's my question.
If I simply reduce by 1 unit, do I commit to staying up for the next 24+ hours?
And if so, how will I ascertain when TiTi is in a stable safe zone., so that I can sleep?
 
Kathy and TiTi said:
If I simply reduce by 1 unit, do I commit to staying up for the next 24+ hours?
And if so, how will I ascertain when TiTi is in a stable safe zone., so that I can sleep?
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I am not one of the high dose gurus, so I will certainly bow to their counsel, if it is different, but I think you should go with the BCS tonight. Then get a +2 and +3, and that should tell you if you can go to bed. I would give her snacks with those tests, too, to keep her from diving, should she have that in mind.

If you go with Wes' formula, 2/3 of her current dose of 11.5 is 7.75 (or 2/3 of her new 10.5 dose is 7 - anyone feel free to check my math). So you could maybe shoot 7 or 7.5 tonight? @Wendy&Neko, @saltycat? What say you?
 
I looked over the SS and I see one BCS back on 8/16 that shot her up pretty quick, it seems that was an unusual reaction, maybe a bounce starting from the 36 earlier in the day. In October you had 2 no shots that did not have quite as dramatic of a rise. That being said, TiTi's recent reductions and low numbers make the old data a little less applicable to her current situation.

The 2 main options are to shoot her new reduced dose, and be prepared for a possible long night. Shoot a slightly reduced dose, somewhere in the 7.5-8.5 range (2/3 to 3/4 dose). Even if you do a reduced dose tonight, you still want to monitor since the depot will still be catching up. By doing the reduced shot you help the depot catch up to the new dose quicker. With all the low numbers recently I would also be inclined to shoot a reduced dose and start with the new dose tomorrow.

More in a min, I know you are getting close to shot time.
 
Tricia Cinco(GA) & Harvey said:
I am not one of the high dose gurus, so I will certainly bow to their counsel, if it is different, but I think you should go with the BCS tonight. Then get a +2 and +3, and that should tell you if you can go to bed. I would give her snacks with those tests, too, to keep her from diving, should she have that in mind.

If you go with Wes' formula, 2/3 of her current dose of 11.5 is 7.75 (or 2/3 of her new 10.5 dose is 7 - anyone feel free to check my math). So you could maybe shoot 7 or 7.5 tonight? @Wendy&Neko, @saltycat? What say you?
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Possibly good news!
She's had no food at all for 2 hours, and she's gone up 16 points in one hour.

I think she's good for her 10.5Units. Although maybe I could go with 10?
 
With the high dose kitties, thinking in percentages can help. Going from 1u to .75u is a 25% reduction, with Titi that would be the equivalent of going from 11.5 to 8.6. Taking a 1u reduction is only a 10%ish reduction which is pretty small compared to some of the reductions the low-dosers:smuggrin: get. Looking at her recent runs in the greens, it looks like she does not have much of a food spike, so if she is flat or a little higher, you can spread the tests out a bit more. If she has dropped by +2 or +3 I would be more vigilant about getting some tests in. The late night tests can be tough, but when unusual patterns appear, like TiTi's recent reductions, a little more attention is a very good idea.

Kathy and TiTi said:
I think she's good for her 10.5Units. Although maybe I could go with 10?
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It's good that she is rising on her own, but the pattern looks similar to last night which dipped her under 50. Personally, I would probably do a little under 10, and start with 10.5 tomorrow.
 
Kathy and TiTi said:
I'm 10 minutes past her shot time now, and still ruminating over the possibilities.
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I think we've all been there, usually with an impatient cat trying to get our attention!

I don't know your schedule tomorrow, that can be a factor in how much you can test tonight if needed. You haven't tried a bcs recently, I know you are worried about breaking the streak, but it might be good to see how she reacts. The depot can take 6+ cycles to adjust, especially with high dosers. Since we are not sure what is causing the drop, I would be a little more cautious. She's had some late nadirs for a lantus cat recently which could be IAA releasing stored insulin. If it is IAA it can break quickly like you saw earlier today.
ETA(Not breaking for good, but a one-time die-off of the antibodies that release their stored up insulin)

Ultimately it is whatever you are comfortable with.
 
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Right now, I'm not comfortable with anything. I'm going to wait and retest. My sense is that she's broken the fall, and will rise steadily. However, the new insulin, in combo with the depot could whisk her back down again. \

As to IAAA? I've not read up on it, and have no idea how it works, nor do I understand how such a condition can store and then release insulin. Can you explain that further, please?
 
Kathy and TiTi said:
However, the new insulin, in combo with the depot could whisk her back down again
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You got it, that is why doing a reduced dose tonight would help let the depot drain a little bit and reduces the chance of a repeat of earlier today.

The 2 common high dose conditions are acromegaly and IAA(Insulin Autoimmune Antibodies).

In IAA, the cats immune system thinks the insulin is a foreign invader and tries to encapsulate and kill it. The Antibodies can sometimes die-off releasing their captured insulin at inopportune times.

In acromegaly, there is a byproduct called IGF-1(Insulin like growth factor) that clogs up the same receptor in the cells that the insulin uses. Since the IGF-1 has plugged up the place the insulin would normally go, it takes more insulin to outcompete the IGF-1. An acro tumor can pulse, releasing more or less growth factor.

Without having the tests done at MSU we don't really know if it is IAA, acro, or possibly a combination.

Copied from a post from Sandy:
Here is what we do know about IAA:
  • Injected insulin first gets bound to the antibodies. Any insulin that does not get bound goes toward metabolizing sugars. How much goes to antibodies and how much goes to metabolizing sugars is anybody’s guess and a moving target
  • IAA can retard the initial rise of available insulin after an injection.
  • IAA can lead to an increase in the half-life of free (unbound) insulin in circulation because some bound insulin gets released into circulation. This increase in half-life can lead to prolongation of action
  • The release of insulin from the antibodies can happen at inopportune times
  • When insulin sensitivity returns, it can happen quite suddenly. At these times, large amounts of insulin previously bound to the antibodies may be released, so avoiding hypoglycemia is a major concern.

 
No harm in stalling as long as TiTi isn't looking at your toes and licking her lips yet:smuggrin:

These decisions can be tough, you've got the tools and experience to know how to bring her up if she does dip, but that comes at the cost of a late night.

I would agree that today's craziness is subsiding, but I'm being a little cautious since she has had a few days recently of running pretty low and would hate to see you have a repeat.
Just saw the 115, good to see her climbing, but keep in mind this AM she started out at 164 and ended up in sharkland.
 
saltycat said:
You got it, that is why doing a reduced dose tonight would help let the depot drain a little bit and reduces the chance of a repeat of earlier today.

The 2 common high dose conditions are acromegaly and IAA(Insulin Autoimmune Antibodies).

In IAA, the cats immune system thinks the insulin is a foreign invader and tries to encapsulate and kill it. The Antibodies can sometimes die-off releasing their captured insulin at inopportune times.

In acromegaly, there is a byproduct called IGF-1(Insulin like growth factor) that clogs up the same receptor in the cells that the insulin uses. Since the IGF-1 has plugged up the place the insulin would normally go, it takes more insulin to outcompete the IGF-1. An acro tumor can pulse, releasing more or less growth factor.

Without having the tests done at MSU we don't really know if it is IAA, acro, or possibly a combination.

Copied from a post from Sandy:
Here is what we do know about IAA:
  • Injected insulin first gets bound to the antibodies. Any insulin that does not get bound goes toward metabolizing sugars. How much goes to antibodies and how much goes to metabolizing sugars is anybody’s guess and a moving target
  • IAA can retard the initial rise of available insulin after an injection.
  • IAA can lead to an increase in the half-life of free (unbound) insulin in circulation because some bound insulin gets released into circulation. This increase in half-life can lead to prolongation of action
  • The release of insulin from the antibodies can happen at inopportune times
  • When insulin sensitivity returns, it can happen quite suddenly. At these times, large amounts of insulin previously bound to the antibodies may be released, so avoiding hypoglycemia is a major concern.
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Thank you. That makes sense.
Since TiTi is steadily rising now, I shot 10U, and I shot it 45 minutes late, so now it's a waiting game.

She was royally P.O.ed at waiting so long for her food, and is now scarfing it down.

I've had a lot of sleep for the past 3 days, so I'm ok with a late night into morning. (Hey, isn't that a paraphrase of an O'Neil play?)
 
saltycat said:
No harm in stalling as long as TiTi isn't looking at your toes and licking her lips yet:smuggrin:

These decisions can be tough, you've got the tools and experience to know how to bring her up if she does dip, but that comes at the cost of a late night.

I would agree that today's craziness is subsiding, but I'm being a little cautious since she has had a few days recently of running pretty low and would hate to see you have a repeat.
Just saw the 115, good to see her climbing, but keep in mind this AM she started out at 164 and ended up in sharkland.
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I am on high alert. Coffee, and a very silly book will see me thru.
 
Sorry, I was out, but it seems like Wes was here to answer your questions. This is likely not IAA as Titi has been diabetic and on Lantus for almost 3 years. And the antibodies tend to be self limiting around a year time frame.

Paws crossed Titi behaves tonight.
 
Lesson learned for next time, a larger dose reduction is needed to interrupt the depot's influence on a cycle.

Surf safe tonight Titi.
 
Wendy&Neko said:
Lesson learned for next time, a larger dose reduction is needed to interrupt the depot's influence on a cycle.

Surf safe tonight Titi.
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Yes. Well, I knew I was just taking a "shot".
I only gave her 10Units this morning to try and further drain the depot. She's bouncing away now.
Should I return to 10.5units at PMPS tonight?
 
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