12/15 Quintus AMPS 490, holy crap PMPS 511 +6 130

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Steph & Quintus & L & O

Steph & Quintus & L & O

Member Since 2017
condo http://www.felinediabetes.com/FDMB/...-445-3-425-6-515-pmps-401-3-281-yellow.188011

Last evening was purple and even yellow until I went to bed! This morning we're back in the red, and I did a few back-to-back tests.

Looks like it's stabilising, right? Going to get back to my vet this afternoon to let him know how things are going, I vote for staying at 3ui and continuing to reduce his carb intake with the food transition.

Thinking of testing at +8 and PMPS and that's it. Sound reasonable?

Would you say the red this morning is a "bounce" from last night, or just that he ate more kibble in his HC-kibble/LC-wet mix early this morning (pre-pre-shot)?

Thanks for your experienced eyes on his spreadsheet!
 
At this stage I see two options: either I up him to 3.5 over the week-end and keep food stable, or I keep him on 3 and continue food transition (should be able to do 2/3-1/3 from tomorrow if today's poop is not horrible). I can keep an eye on him during the week-end, but not on Mon-Tues-Thur-Fri.

What would you advise?
 
To me it looks like he’s doing what my cat is doing - bouncing. He was down in yellows that is unusual territory for him from blacks and reds and the body freaks out and numbers go high. I’ve been told a bounce can last three days. It’s upsetting after seeing better numbers but I’d wait it out and don’t change the dose. Let him ride out the bounce and see where it takes you.
 
He does look like he needs more insulin, but.....
1) with kibble still in the picture, you would be looking at holding the dose fireball week as per the slgs guidelines.

2) even on TR (which requires kitty to be on an all wet, low carb diet) a dosecrease to 3.5u would be too much, on TR you would take him to 3.25u.

So in summary for now when he's on kibble I would recommend following slgs and holding the dose.
When you do transition him to an all wet LC diet then you can swap to TR.
 
Um..... @Gill & George -- When the majority of nadirs are over 300, on TR you can increase by 0.5u. From the TR sticky:

INCREASING THE DOSE:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...
I think the issue is more whether this is a bounce or not and I suspect that it is. Even with a bounce, the numbers are high enough that I'd not be overly concerned about increasing if this weren't a newly diagnosed kitty. Right now, we don't have much information as to how quickly a bounce may clear. So far, it looks like it takes 3 days.

Stephanie -- so you understand my comments, when a bounce breaks, numbers can drop back to the around the previous nadir. That drop can have some momentum behind it. If you increase the dose at the time the bounce is breaking, there's a reasonable chance you could increase the momentum behind the drop which means you are in a situation whereby you need to be on hand to aggressively monitor where BG levels are and potentially intervening just as aggressively. It is not a situation I recommend especially to someone who is new to managing low numbers.
 
Sienne and Gabby (GA) said:
Stephanie -- so you understand my comments, when a bounce breaks, numbers can drop back to the around the previous nadir. That drop can have some momentum behind it. If you increase the dose at the time the bounce is breaking, there's a reasonable chance you could increase the momentum behind the drop which means you are in a situation whereby you need to be on hand to aggressively monitor where BG levels are and potentially intervening just as aggressively. It is not a situation I recommend especially to someone who is new to managing low numbers.
Click to expand...

Makes sense. Don't want to combine "bounce-clearing low" with "higher dose low".

When you say "this is a bounce", you mean today's red numbers, following last night's lovely purple and yellow? (at least it's not back up in the blacks...)
 
x1zGUgGvxZRmLrm1ErGlTSAMPOZ-gyXQnJrezFbNot8Q2awnwcI5GnmLIALx9u7RuZHz57Lr9537OUdpILv1TxyTM32w1KeCROIXN4FpGyjLlACoWdt-_cuPlMMPi9N31fGZ0pmow1wp6zk-vFzDDfpmKH2RioKNQbwBgTtWObpyvhFk9TYLp1V4mt4fU35Dv-FlpfG_-ZxgraBAMhrDXdKoQgoh6vRos6LWypokbyn1ZeqA9pt7tw0wtu7BISI0isQ988lbcL5AH9wqgVWzwhKP_0m2vYFyo3-HIdCMJMYbqdJKqWgYYgyafpteVpraMRMszKD_95wRC9kmsT5hRkekyKhF1iRd0XSMwQWZiNu8BRhKiUeq1miuFgF3icZPPQLH7Kkgw3_twlutUiToleX02vd-pj4a5Nr7zxuL2lIcOrSYTdJLmbH6XmWU_foN12EFGKP8qEKn-dZ2HVGi-34oK2_I6fN1EmPmXHOiv-Wd2sNGmMTCLguaUrNB4mxlD702mcdj8znwseKUdqKZdlDtpDOacD977XFF-BDBprG9ZIECY1KDLF2dYSWFNinPTBM-mPuTwNbUAMrJvtuJrCU99xPAwbtNn_ohawkaZ8o=w1033-h775-no

He just turned around on his side a bit, "comfy". This is him right now in his evening purples.
 
Stephanie & Quintus said:
Whoops, vet need their spare glucometer back, the other one has stopped working. Sticking with 3, but we sadly are going to be blind this week-end!
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Oh no please don’t shoot blind. Especially now as his numbers are dropping. Most pharmacies offer a free meter when you buy strips. I think Wal-Mart does? Please find out and get yourself a meter.
 
Juliet said:
Oh no please don’t shoot blind. Especially now as his numbers are dropping. Most pharmacies offer a free meter when you buy strips. I think Wal-Mart does? Please find out and get yourself a meter.
Click to expand...

Seriously, we're so high up that it wouldn't worry me too much over the week-end. But I did get another meter.
There is no Wal-Mart in Switzerland :-p
 
Yes -- you interpreted my note correctly. Since Quintus hasn't spent much time in "yellow" numbers, that drop from 511 to 272 likely triggered a bounce. Bounces can occur due to a drop into low numbers (e.g., in the 40s), lower numbers than your cat is used to, or a fast drop in numbers. In Quintus' case, he dropped into the yellows which is a zone he's not used to spending much time in. In addition, a drop of well over 200 points within 3 hours is what I would consider a fast drop. We also don't know if he dropped even lower.
 
It's a great sign!! It's telling you that Quintus is clearing bounces more quickly and his body is getting used to lower numbers. What you're also seeing -- and what may be good information for the future -- is that like many cats, he seems to have an active PM cycle. This is why testing in the evenings is so crucial.
 
Cat's probably have a more active PM cycle so they can keep up awake to all hours. (Just kidding. I really have no idea why.)

"Active" can vary. We typically mean it to suggest that you will need to do more testing to insure your cat is in safe numbers or to make sure you catch a reduction-worthy number.
 
With a depot insulin, dosing different amounts in the AM and PM isn't an effective strategy. Keep in mind that every time you change the dose, it has an effect on the depot. If you shoot differing amounts at each shot time, the depot never settles down and the result is "wonky" numbers. Just like some cats experience lower numbers at night, some cats see higher numbers in the early morning. This is called "dawn effect" and is a result of cortisol levels rising in preparation for the stress of the day. You don't want to try to shoot those numbers down. Rather, over time, those AMPS numbers will begin to fall into line.

 
You may need to go to the Sanofi site. There's information in other places about depot medications but they all really vary in their duration. As far as many depot meds go, Lantus and Lev are relatively short acting. Some meds last for weeks.

With Lantus, the drug is acidic and when injected into a more basic environment, it forms microcrystals in adipose tissue. Those crystals dissolve over the course of the cycle. As a result, you're always adding a bit to the depot as insulin is dissolving. Ideally, it forms a steady state. However, stress, activity, food, etc. all effect the utilization of the active and stored insulin. It also helps to keep in mind that insulin is a hormone and doesn't act like an antibiotic. Further, unless the beta cells in your cat's pancreas are completely nonfunctional, they may also pump out endogenous insulin just to make life interesting.
 
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Sienne and Gabby (GA) said:
the drug is acidic and when injected into a more basic environment, it forms microcrystals in adipose tissue. Those crystals dissolve over the course of the cycle. As a result, you're always adding a bit to the depot as insulin is dissolving. Ideally, it forms a steady state. However, stress, activity, food, etc. all effect the utilization of the active and stored insulin
Click to expand...

Yeah, got that far, the bit I'm interested in is the rate at which the depot penetrates the blood stream. Obviously, if we're looking at 5-6 cycles to build the depot, it's longer than a cycle. I'm also interested in whether the available insulin in the blood stream changes the rate of penetration (I guess there is an issue of chemical equilibrium in this story, so I suppose it does).

Sienne and Gabby (GA) said:
Further, unless the beta cells in your cat's pancreas are completely nonfunctional, they may also pump out endogenous insulin just to make life interesting.
Click to expand...

OF COURSE otherwise it wouldn't be fun.

Side note: just had normal poop. Which seems to tell us that he is at least able to withstand a 50/50 HC/LC mix. Yay!

Now: do I need to stay up until he starts going back up?
 
Stephanie & Quintus said:
Holy crap we just hit blue: PM+4=171
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Sorry, just catching up, Asia has given me a bit of a reprieve today and I have taken full advantage. :p

:cool::cool::cool:

YAY! Isn't that something?

I'm glad you were able to find another monitor, could you imagine missing that blue?

Nobody can really say if it's safe to go to bed. Early on, I stayed up until Asia was on the rise, the more sleep deprived I get, that's not so much a reality. Now I try to stay until nadir and nap and set my alarm to catch numbers around where I know she has dipped before, every 2-3 hours. It seems like a high enough blue, I wouldn't be too worried, but then again, were you even expecting to see this blue in the first place?

Also, don't get discouraged if he bounces again after this, he will come back. ;)
 
So, he might have had a little less kibble in his food mix today. And he had the antibiotic injection yesterday noon.

Could one of those explain why he's sliding down the ladder? This feels like too much, too fast.
 
Stephanie & Quintus said:
Still going down. 130 at +6. Now I'm starting to worry. And not just because I need sleep.
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Who is this cat? :joyful:

130 is perfectly safe. He could keep dropping, and could have a little extra go from clearing the bounce. You are doing a great job monitoring him and if this keeps up and you switch food, I think you'll be done with 3 units shortly and heading down the dose ladder instead of up. What a difference a day makes! ;)
 
Stacy & Asia said:
You are doing a great job monitoring him and if this keeps up and you switch food, I think you'll be done with 3 units shortly and heading down the dose ladder instead of up. What a difference a day makes!
Click to expand...
Makes me all the more glad I decided to stick with the dose and continue with the food... I don't see how he cannot be bouncing all over the place tomorrow, honestly! He's resting like a little angel next to me (though he bit my fingers before... he does that... good sign).
Does one immediately feel better with lower BG? I have no personal experience with that.
 
Should I make him eat some more? I'm worried he may not have eaten quite enough today and this evening.

Answer: I'm making him eat. And given how he's eating, I'm going to prep more food for the night. Pretty certain he didn't really eat enough today, which might also explain the low numbers.
 
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Stephanie & Quintus said:
Does one immediately feel better with lower BG? I have no personal experience with that.
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Not necessarily. Asia was most happy in pinks to start and didn't seem bothered in reds or blacks either. :rolleyes: Her first blues and greens she was sleepy. Over time it changed and she was happy in green, low greens even, and now she's snoozy when she goes high. But sometimes still quite pleased in pinks! :p

My experience with her is that the numbers don't always dictate how she is feeling, I believe they are cumulative, and if she's spending a lot of time in blues and greens, the higher numbers for a few hours or a day don't tend to have much of an effect (behavior wise).
 
Stephanie & Quintus said:
Does 139 count as going back up?
Click to expand...
Given meter variance i would say that is flat.

When did he last eat and how much, and what was it?

Sienne and Gabby (GA) said:
When the majority of nadirs are over 300, on TR you can increase by 0.5u
Click to expand...
I agree Sienne, my bad for not making it clear.
I felt that in this case with the kibble still being in the picture but in the process of it being reduced it was possible we might see some lower numbers before long. So my reference to TR was more on how I felt I would apply it in this case rather than a general rule.

Though of course TR should not be followed while there is dry in the picture, as it is a pre requisite of TR that kitty be on a wet LC diet.
 
Not really. You need to remember to factor in the 20% variance due to measurement error (i.e., error variance from the meter). 130 vs 139 is flat. Gill and I are in agreement -- which is more the case than not.

When Gabby was first diagnosed, I would lose a lot of sleep. At one point, I mentioned to someone that sleep was vastly overrated. Many people will "sleep test" -- set an alarm and test the kitty and go back to sleep if they are concerned about where their cat's numbers are heading.

I guess you're seeing first hand what an active cycle is all about. Sorry (sort of).

Stephanie -- I saw in Yum's condo that you've been giving Convenia. Please be very careful. Given that it lasts over 2 weeks, if there is any chance of an adverse reaction, with that long acting of a drug, it becomes a very dicey situation. My vet will not use it. It's only indication is for skin infections despite the fact that some vets prescribe it so caregivers don't have to pill their cat.
 
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Gill & George said:
When did he last eat and how much, and what was it?
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He finished his "half-day bowl" shortly before my +7. That means that he had half his daily ration between +1 and +7. It's a mix of NF and DM (transitioning), currently at 50% HC and 50% LC. I've prepared a half-helping of the same mix and plan to make him eat before sleeping. I've left a bowl out with NF kibble as an emergency ration (he prefers the wet stuff).

Sienne and Gabby (GA) said:
Not really. You need to remember to factor in the 20% variance due to measurement error (i.e., error variance from the meter). 130 vs 139 is flat. Gill and I are in agreement -- which is more the case than not.
Click to expand...

So I can't go to bed yet :-(
 
Well, I might give him some of the food you put together and test in 30 min or so and see where things are heading.

I also added something about Convenia to my post above.
 
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