Help - not sure how to handle really low ps numbers.

[Connie Kaplan]

My Kitty is all over the place and I know I need to be more consistent with dose but it varies so much and It's been 4 months. He was in remission for a year. Kept increasing dose and 5 was the only dose that would bring him down even to green numbers. Now things seem to be changing and he bounces drastically but goes lower. Yesterday I had a 500 amps and a 56 pmps. What to do? I feed until I got a higher number and gave him .5 units. This am his number was 600! So should I have waited longer and given him more. Feel like I'm going crazy.

 

[Connie Kaplan]

Also I am using both the alphatrack and the Relion because I wanted to see which was more accurate. Seems like the alphatrack was closest to vet's meter and blood test so think it's closer bit about 10-20 points high. The relion is really low I dropped my AT meter a few days ago and now there is a wider spread. I think I should get a new meter. I did a test solution which came out ok. Anyone else ever compare and have this big of a spread. There is usually a 50-100 point difference

 

[Nan & Amber (GA)]

I think the different types of meters are expected to have a pretty wide range of differences, no matter what. Even worse, the expected difference changes with the reading (usually, it's bigger at higher numbers). There's really no consistency, you'll drive yourself crazy trying to understand what's going on! Just pick one meter and stick with it for a while-- if you are suspicious of your AT2, then maybe just use the Relion for a while and see if you can start to understand Junior's patterns with that.

As for those patterns... The main thing I see on Junior's spreadsheet is biiiiiiig bounces! That 36 on the Relion yesterday was probably enough to shoot him into the stratosphere for a while. It may be that the dose he's on is too high for him-- actually, it's quite possible it's been too high for a while. Without a lot of tests between shots when the insulin is at peak action, it's hard to tell how low these doses have been taking him.

If daytime mid cycle tests are a problem, is there any way to start getting a few more readings at night? A few +3 or +4 would go a long way to help in assessing how he's doing on a particular dose. I'm hoping some folks with more dosing experience than me will be able to weigh in here, but my suspicion is that this dose is too high.

 

[Connie Kaplan]

I think the different types of meters are expected to have a pretty wide range of differences, no matter what. Even worse, the expected difference changes with the reading (usually, it's bigger at higher numbers). There's really no consistency, you'll drive yourself crazy trying to understand what's going on! Just pick one meter and stick with it for a while-- if you are suspicious of your AT2, then maybe just use the Relion for a while and see if you can start to understand Junior's patterns with that.

As for those patterns... The main thing I see on Junior's spreadsheet is biiiiiiig bounces! That 36 on the Relion yesterday was probably enough to shoot him into the stratosphere for a while. It may be that the dose he's on is too high for him-- actually, it's quite possible it's been too high for a while. Without a lot of tests between shots when the insulin is at peak action, it's hard to tell how low these doses have been taking him.

If daytime mid cycle tests are a problem, is there any way to start getting a few more readings at night? A few +3 or +4 would go a long way to help in assessing how he's doing on a particular dose. I'm hoping some folks with more dosing experience than me will be able to weigh in here, but my suspicion is that this dose is too high.

Thanks! I feel that way also but in the beginning we had to keep increasing since they weren't budging. Kind of want to start all over. I just gave 4 instaed of 5 this am evn though the number was so high. going to try this decrease.

 

[Connie Kaplan]

Thanks! I feel that way also but in the beginning we had to keep increasing since they weren't budging. Kind of want to start all over. I just gave 4 instaed of 5 this am evn though the number was so high. going to try this decrease.

Also that is what I was wondering when it got so low. At what glucose level would the kitty somogy? I know they say 60-80 is normal but always makes me nervous. If you ever had this experience - here it shoots up for a while afterwards? What did you do? Lower yhe dose right away?

 

[Kris & Teasel]

Also that is what I was wondering when it got so low. At what glucose level would the kitty somogy? I know they say 60-80 is normal but always makes me nervous. If you ever had this experience - here it shoots up for a while afterwards? What did you do? Lower yhe dose right away?

Without getting into the debate about the Somogyi phenomenon, bouncing is very common and can make it very hard to assess a dose. Some cats are much bouncier than others - like mine!
Here's a description of bouncing I wrote a while back:

Here's how it works:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

So - bouncing to high BGs can happen even if the BGs doesn't drop very low. The colour coding on your spreadsheet should follow the FDMB template, in that any BG below 68 with an AT meter shows as lime green. You have a much broader range of lime green (1-99). That will confuse people who look at your SS. Having said that, the 4.25 u dose dropped him too low (36 ) and that caused the rebound to black.

Your best bet is to go post on the Lantus forum to get help from the large group of very experienced people there. Also, it's worth taking the time to read the yellow info stickies that describe how Lantus works and outline the two sets of dosing guidelines recommended for Lantus (TR or SLGS).

 

[Connie Kaplan]

Thanks so much.

 

[Juliet]

Without getting into the debate about the Somogyi phenomenon, bouncing is very common and can make it very hard to assess a dose. Some cats are much bouncier than others - like mine!
Here's a description of bouncing I wrote a while back:

Here's how it works:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

So - bouncing to high BGs can happen even if the BGs doesn't drop very low. The colour coding on your spreadsheet should follow the FDMB template, in that any BG below 68 with an AT meter shows as lime green. You have a much broader range of lime green (1-99). That will confuse people who look at your SS. Having said that, the 4.25 u dose dropped him too low (36 ) and that caused the rebound to black.

Your best bet is to go post on the Lantus forum to get help from the large group of very experienced people there. Also, it's worth taking the time to read the yellow info stickies that describe how Lantus works and outline the two sets of dosing guidelines recommended for Lantus (TR or SLGS).

Wow thanks for this! I’ve been so confused as to the whole bouncing thing.