07/09 Max; PMPS 368, +6 366; AMPS 707, +3 716. Can dose increase be wrong choice?

Rebecca & Max (GA)

Rebecca & Max (GA)

Member Since 2020
I just increased Max from 1U to 1.25U three days ago (after many cycles of really high highs). He slowly began to come down and I saw a few great numbers and had high hopes we’d found his right dose. Then this morning he read 707 on my AT, and HI on my Contour meter. I only had 4 hrs of sleep and took a nap, sleeping thru his +2 time. A test at +3 had him 717 on the AT, but 490 on the Contour ((yes, I know two meters is confusing for some, but I’m not ready to give up the AT just yet- esp. as sometimes I only have enough blood for the AT)). I posted this morning before AMPS on the FB group to ask about using food to help control bounces (Max tends to go lower, drop low, then shoot high). One FB member has been consistently telling me that Max’s dose is WAY too high...yet even we I dropped him down to 0.25U, he still had reads in the 400-500s. I know the use of the Libre messes things up, as does my using two meters, but is there any validity in what the FB member is saying?

Here is his explanation:
“Once the dreaded checkmark appears (meaning you've had an overdose or the cat's body thinks you have), you'll see unresponsive high numbers for a few days (not more bouncing, just more stored glucose released).

So if he's ever had a real checkmark or a hypo at 1U, then 1U is still too much. You've just jumped the gun and given him more while he's still artificially (defensively) high.”

I don’t follow dosing advice on FB, but he is really making me think about this and Max’s test results. I had hoped 1.25U was good, as Max has been somewhat flat with reads- until his AMPS. ARGH!!!!
 
Here's is your last post for continuity and for others to see the history...https://www.felinediabetes.com/FDMB...ve-or-increase-dose-amps.231993/#post-2594055

So, here's the thing. Everyone is entitled to an opinion, or an approach. I'm not going to poo-poo what someone else has given you elsewhere. But, I can tell you what I see. No way there is "hypo" at 1u...where in the world would that even be possible given the numbers in your SS?! Numbers are high, regardless of the meter you are using. This would indicate to me some level of glucose toxicity setting in, which means that Max is getting just a wee bit too comfortable in high numbers.

The best approach, in my mind is to continue to increase until you find the right dose. SLGS has safety built in, as does TR so my suggestion is to follow the guidelines and you'll get there. May I ask why SLGS? You are testing enough, and aren't feeding dry, and with TR you could consider increasing sooner than with SLGS. He's not doing much but sitting in high numbers at the moment, and even bounces from a perceived "low" would *usually* clear in six cycles. Please continue to ask questions.
 
Christie & Maverick said:
Here's is your last post for continuity and for others to see the history...https://www.felinediabetes.com/FDMB...ve-or-increase-dose-amps.231993/#post-2594055

So, here's the thing. Everyone is entitled to an opinion, or an approach. I'm not going to poo-poo what someone else has given you elsewhere. But, I can tell you what I see. No way there is "hypo" at 1u...where in the world would that even be possible given the numbers in your SS?! Numbers are high, regardless of the meter you are using. This would indicate to me some level of glucose toxicity setting in, which means that Max is getting just a wee bit too comfortable in high numbers.

The best approach, in my mind is to continue to increase until you find the right dose. SLGS has safety built in, as does TR so my suggestion is to follow the guidelines and you'll get there. May I ask why SLGS? You are testing enough, and aren't feeding dry, and with TR you could consider increasing sooner than with SLGS. He's not doing much but sitting in high numbers at the moment, and even bounces from a perceived "low" would *usually* clear in six cycles. Please continue to ask questions.
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Back at the end of May when he was on 1U, he dropped to 53 on the AT meter. This was after him dropping to 53 at the vets while on 2U (that was all prior to me joining here but I added it to the SS because those were the only reading I had then. That’s where the hypo came from. He has only gone low once since then, while on the Libre (50 was seen on the graph after I tested him and he read 67), so definitely not a hypo IMO and nothing even remotely close to a hypo since then.
I had only chosen the SLGS method because ear sticks have been really difficult with him (I’m now gloved up so he can bite or scratch me as much as he wants). I’d love to just keep him on the Libre because it’s so easy to check him (and I get a ton of info from the graphs it generates), but the last one only lasted 6 days, and I feel I need to master ear sticks. Having said that, I didn’t think I was testing enough with ear sticks to try TR! Hanging for a full week with him so high kills me, but I think I’m scared I may miss him dropping too low. Perhaps it’s time to just go for it? I’m home so I’d be here to test. Will TR help him get used to not being so comfortable at high numbers? And sorry for not including the previous post- thank you for adding it!
 
I honestly don’t see anyway that he could be on too much insulin. If any part of you wants to check that you could have your vet run a fructosamine. No meter is perfect so an average that way will show you just how high he has been overall the past few weeks. To do TR you do need to be able to test at least two times per cycle and much more when dropping fast and low. I guess if you ran into trouble and just couldn’t test when needed you could abort the cycle with lots of high carb food but that would only be in an emergency. I think the low test you got initially happens sometimes when a cat first starts insulin. I do think you need to get more insulin into him somehow to break the resistance. TR would help a lot more than SLGS provided you can test or get another Libre.
 
Rebecca & Max said:
One FB member has been consistently telling me that Max’s dose is WAY too high
Click to expand...
Which FB group is that? The one associated with this forum is not supposed to be giving dose advice. If another FB group (and I suspect it is), some of them give really bad advice. I agree with Christie's comments, except I am going to poopoo the other person's advice. :p Too many times I've seen other FB groups says to lower the dose, the cat gets even worse glucose toxicity, and I've even see a few get really sick with DKA as a result.
Rebecca & Max said:
Back at the end of May when he was on 1U, he dropped to 53 on the AT meter.
Click to expand...
What a cat does more than two weeks ago is ancient history in terms of dosing. Glucose toxicity creeps in much faster. He might also have had some of the 2 unit depot working against you.

If for some reason you'd started at a really high dose, hadn't been testing to see how low the dose is taking the cat, done really large increases, then there would be a possibility of an overdose. None of those are true. You started low, do a lot of testing (enough for TR), and increased by small amounts. Therefore, the dose is just too low.

TR allows faster increases. The solution to glucose toxicity is enough insulin to overcome it. Getting there faster helps.
 
That 53 was likely due to the 2u depot, but in any case, we tend to look at numbers from 2 weeks past, maximum, what happened in May on a dose is ancient history, as the current dose and how he is doing with it is more important. Also bear in mind that the term "hypo" is often used a bit loosely. Lower numbers don't necessarily mean *symptomatic* hypoglycaemia. It doesn't mean you don't need to pay attention and get numbers up to a safe range, but I often see people misuse the word.

I'm sorry the BG tests are sometimes difficult, good for you in continuing to try and find safe ways to get the ear pokies in! I hope they get easier to you in time. One thing I'd suggest also is to try and see if you can figure out your cat's response to the insulin, the basics are so important: understanding concepts of onset (length of time the insulin reaches bloodstream and begins to lower blood glucose), nadir (lowest point in the cycle) and duration (how long does the dose continue to lower BG). Once you get a feel for this, you can adjust testing, and take breaks when warranted. Have you seen this sticky about what an active cycle on Lantus might look like? https://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/

Many people find the +2 or +3 can be a good indication of where the cycle may go. As an example, today, +3 was about the same as AMPS, and quite high so to me, I wouldn't have bothered with another test.
 
Wendy&Neko said:
Which FB group is that? The one associated with this forum is not supposed to be giving dose advice. If another FB group (and I suspect it is), some of them give really bad advice. I agree with Christie's comments, except I am going to poopoo the other person's advice. :p Too many times I've seen other FB groups says to lower the dose, the cat gets even worse glucose toxicity, and I've even see a few get really sick with DKA as a result.

What a cat does more than two weeks ago is ancient history in terms of dosing. Glucose toxicity creeps in much faster. He might also have had some of the 2 unit depot working against you.

If for some reason you'd started at a really high dose, hadn't been testing to see how low the dose is taking the cat, done really large increases, then there would be a possibility of an overdose. None of those are true. You started low, do a lot of testing (enough for TR), and increased by small amounts. Therefore, the dose is just too low.

TR allows faster increases. The solution to glucose toxicity is enough insulin to overcome it. Getting there faster helps.
Click to expand...
It is the one associated with this group!! One specific person keeps hinting I’m overdosing. While I trust you all here, I am allowing seeds of doubt to be planted. I too feel he’s too low. I’m thinking he’ll be happy somewhere between 1U & 2U. Back then, I didn’t know better than what my vet told me. Max spent two weeks at 2U, with me blind dosing much of the time ((shudders at the memory)). My vet looked over his first Libre results and the AT info I sent and told me to go right from 0.5U to 1U, and told me going to 0.75 would be too hard to dose (insert eye roll). I did the second Libre on my own, and still have a script for 1 more (I can keep it as a back u of ear sticks tank again), so I’m thinking it’s time to give TR a try!
 
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Christie & Maverick said:
That 53 was likely due to the 2u depot, but in any case, we tend to look at numbers from 2 weeks past, maximum, what happened in May on a dose is ancient history, as the current dose and how he is doing with it is more important. Also bear in mind that the term "hypo" is often used a bit loosely. Lower numbers don't necessarily mean *symptomatic* hypoglycaemia. It doesn't mean you don't need to pay attention and get numbers up to a safe range, but I often see people misuse the word.

I'm sorry the BG tests are sometimes difficult, good for you in continuing to try and find safe ways to get the ear pokies in! I hope they get easier to you in time. One thing I'd suggest also is to try and see if you can figure out your cat's response to the insulin, the basics are so important: understanding concepts of onset (length of time the insulin reaches bloodstream and begins to lower blood glucose), nadir (lowest point in the cycle) and duration (how long does the dose continue to lower BG). Once you get a feel for this, you can adjust testing, and take breaks when warranted. Have you seen this sticky about what an active cycle on Lantus might look like? https://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/

Many people find the +2 or +3 can be a good indication of where the cycle may go. As an example, today, +3 was about the same as AMPS, and quite high so to me, I wouldn't have bothered with another test.
Click to expand...
What I had found using the Libre both times was that Max usually went up at +1, then would drop to nadir between +5 to +7 (+6 was his average); then he’d climb back up. That was seeing the graph it generated. With ear sticks, I really had no idea as I could only get a test here or there. However, yesterday was the first time I hadn’t seen big drops at +6 with ear sticks. He was close to his PS read, which had me thinking he was getting stable- no dip down. And then the AMPS told me otherwise. My other hurdle with TR is the nighttime reads. Our current PMPS is at 12:30 AM! I keep trying to work him back by 15 min, but then something messes it up (testing him takes 30-45 min, or me forgetting like today). If I shoot him at 12:30 AM, I get to bed around 1 AM or later. Waking up at 2:30 or 3:30 isn’t something I really ‘want’ to do. If he wakes me up for food before 4 AM, I do try to test him, but more often than not I’m too sleepy, or he’s too angry (this is where the Libre wins me over- just scan and go back to sleep). I was falling into a +4 and +8 reads, so if that would give me the info I needed, I’d feel better trying TR.
 
You can move the cycle 30 minutes every 24 hours. It might be easier than 15 minutes each cycle. Testing will get easier. I was lucky my Max was easy. Treats helped too but he was easy. My three year olds are hard to even pill so I understand. :bighug:
 
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