? 9/8 Dora AMPS 65 / 61

[Dora the Explorer]

Link to previous: https://www.felinediabetes.com/FDMB/threads/8-31-dora-pmps-246-am-176-174.234394/#post-2623673

I’m a little anxious! Dora had a good day with some numbers in the 100s earlier this week during nadir. Her preshots were higher. Yesterday we didn’t get a mid cycle test as we were traveling with her but her PMPS was nearly 400 so after a two hour car ride with her mangled up ears I figured she’d be fine to skip a bedtime test.

So her AMPS was 65. Try again. 61. It’s been 12 hours since her shot so I’d doubt she’ll drop more but I panicked and gave her about a half a can of gravy lovers. I’ll skip the shot. What’s next? I’m so discouraged with these wild swings. I’d never have expected this after such a high high last night.

I’ll call the vet later but the last time she had us go to once a day and it took months to recover from that bad advice. When Dora was first diagnosed we didn’t have a monitor for the first week and our first reading (human) was 72. By the was those 60’s today are AlphaTrack.

Thank you! Going to drink coffee and retest her now that she’s eaten. I’d be surprised if she goes lower but I’m concerned she had lower lows overnight.

 

[THH & Snowcrash (GA)]

We commented back and forth on facebook, but I think her numbers on 1.25 units look the best... has anything else changed in her routine since then?

Sometimes increasing insulin can lead to higher blood glucose levels; and that can be a sign that the cat is dipping too low sometimes and the body is releasing glucagon to compensate. If that happens too often, blood glucose levels will start staying high.

We had a cat at the rescue whose Lantus was up to 4 units, and his pre-shot values were 400-500s... when we did a curve, we found his midday values were in the 40s! He ended up being at 2 units long-term and ran better numbers there until lymphoma complicated things.

 

[Dora the Explorer]

Hi! And thanks. Nothing has ever changed although I have cut out nearly all dry food and replaced with freeze dried chicken for treats. It seemed like she’d do well on a dose and then go low and I’d back off and then she’d go higher and I wouldn’t be able to get he back down. She’s never been in the 60s though, I wish I’d tested at bedtime. But it may be that she’d have been 200s and didn’t drop till later. This is also a new pen, if that matters, and I’ve been shooting along her flank more than scruff lately.

 

[THH & Snowcrash (GA)]

Hi! And thanks. Nothing has ever changed although I have cut out nearly all dry food and replaced with freeze dried chicken for treats. It seemed like she’d do well on a dose and then go low and I’d back off and then she’d go higher and I wouldn’t be able to get he back down. She’s never been in the 60s though, I wish I’d tested at bedtime. But it may be that she’d have been 200s and didn’t drop till later. This is also a new pen, if that matters, and I’ve been shooting along her flank more than scruff lately.

Was the diet change made at the same time as the insulin increase?

 

[Dora the Explorer]

Was the diet change made at the same time as the insulin increase?

not really. I used to give it to her when she’d get a test or shot. I think I tried taking away the dry food first and that didn’t seem to work so called the vet and they upped the dose. Since we have also been traveling with her twice a week since the end of July I thought that might be a factor too. But it doesn’t seem to be anymore.

 

[Sue and Luci]

Congratulations on the reduction Dora earned this morning.

 

[Sue and Luci]

Sometimes increasing insulin can lead to higher blood glucose levels;

Are you referring to a bouce?

 

[Dora the Explorer]

Congratulations on the reduction Dora earned this morning.

Thank you! I’m so nervous. Every time I get encouraged and start skipping or lowering when numbers are low she shoots back up. What dose would you recommend for tonight, assuming she’s high? Just a 0.25 reduction?

 

[Sue and Luci]

Yes, you're using the AT2 meter and SLGS - reductions earned when they drop under 90 on SLGS.

 

[Dora the Explorer]

Yes, you're using the AT2 meter and SLGS - reductions earned when they drop under 90 on SLGS.

That’s what I read. I thought I also read they can be hypersensitive to insulin after a hypo and while she wasn’t having any symptoms at 61 on the AT she was pretty low and I don’t know where she was overnight.

 

[THH & Snowcrash (GA)]

Are you referring to a bouce?

Yes, but also explaining how prolonged bouncing can lead to hyperglycemic symptoms as well. It can be counterintuitive to reduce insulin when blood glucose levels seem to be increasing.

 

[THH & Snowcrash (GA)]

That’s what I read. I thought I also read they can be hypersensitive to insulin after a hypo and while she wasn’t having any symptoms at 61 on the AT she was pretty low and I don’t know where she was overnight.

I'm not seeing any numbers on her spreadsheet after yesterday AMPS. How has she been since then?

 

[Sue and Luci]

Thank you! I’m so nervous. Every time I get encouraged and start skipping or lowering when numbers are low she shoots back up. What dose would you recommend for tonight, assuming she’s high? Just a 0.25 reduction?

Did you skip last night? No PMPS, no shot?

 

[Chris & China (GA)]

Hi Jane! This is Chris from the FB group.

First, as for this morning, if something like that happen again, try giving just a little of your regular low carb food and then test again in 20-30 minutes. We want to try to nudge them up above 68 but (hopefully) not send them to the moon.

If you keep getting Pre-shots too low to shoot, that's a good indication the dose is too high.

Next, Dora has earned a reduction by dropping below 90! (Congratulations!!) Tonight, as long as she's high enough, her new dose would be 1.75.

If you get a PS that's too low to shoot (under 150 but above 90) you can try stalling. When you stall you don't want to feed and then test again in 20-30 minutes to see if the number is going up. It can be helpful to use some of that time to post here but make sure your subject line is clear that you're stalling and need help quickly. I suggest "STALLING! NEED HELP!"...LOL
Usually that gets someone's attention ....and we have a tradition here. If someone encourages you to shoot a lower number than you're used to, they agree to stay online and watch for updates so that you're never shooting "alone". ....no matter how long it takes (or they will find someone else with experience to take over) Many of us have spent most of the night online watching for updates when we encouraged the human to shoot. We call them PJ parties!

It's really important for you to start getting some mid-cycle tests in. We have seen cats here that could go from 400 to 40 and back to 400 by the next shot time. If you just saw the 400's, you'd think the cat needed more insulin, when in fact, they needed less!

I don't know what your life schedule is like, but if at all possible, it would be really helpful to get at least 1 test somewhere mid-cycle on the AM cycle (like 5-7 hours after the morning shot) and on the PM cycle, at least a "before bed" test. If you can't test during the day due to work, it's even more important to try to get at test or two on the PM cycle. Most cats do drop lower at night so we want to make sure Dora is safe before you go to sleep.

On SLGS, you should be doing a curve at least once a week, so on a day off you should test every 2 hours for 12 hours or every 3 hours for 18 hours so we can get a better idea of what's going on in Dora's body.

Hang in there! It can take awhile for a cat to settle into anything even closely resembling a pattern! With China it was a good 5-6 months!

 

[Dora the Explorer]

Thanks Chris! She was sky high as I expected by tonight. The food only took her up to 141 an hour later. She’s 490 and having dinner now. I’ll do the 1.75 I think but the vet just called - I missed her - and wants me to do 1.5 and bring her in for freestyle Libre . Should I do that? I can just test her more often if needed? My vet moves in 0.5 increments. I tried calling her back but didn’t get her. Unfortunately since it’s also an emergency vet hospital I have to wait through long messages to even get to her mailbox or an operator.

 

[Chris & China (GA)]

Most vets don't seem to understand that we CAN do .25 and .75 unit shots. Heck, a lot of them don't think there's such a thing as half unit doses!

As for the Libre, that's up to you. Personally I don't see why vets are so keen to use them (I guess it's because it's the new toy in town). The same vet that will swear that you HAVE to use a pet meter to test at home and can't use a human meter jumps at the chance to apply the Libre (which, by the way, is also a human meter!)

Even with the Libre, you still need to home test with your current meter, especially if the Libre is showing a low or high number. Also, the reading on the Libre is going to be delayed by about 15 minutes and if your cat is running low, you need to know where they are NOW, not 15 minutes ago.

It will only last 14 days at the most....and a lot of kitties get them off long before then (I know of at least 2 that got them off within an hour of getting home)...then you have to buy a new unit...you can't replace the one that got knocked or scratched off. Sometimes they shut off before the full 14 days too.

If you absolutely can't get tests in between the shots (and your cat will keep it on) it could be helpful to see what's going on in between the shots though.

Personally, if you can test more often, I'd skip the Libre and just start testing more! JMO

 

[THH & Snowcrash (GA)]

FreeStyle Libre is great for getting 24/7 readings. You can still test her ear bg too. It's just more data.

 

[Sue and Luci]

I can just test her more often if needed? My vet moves in 0.5 increments.

If you can test yourself, please do a few more tests during the day and at night. I personally wouldn't waste my time or money on getting a Libre. But that's just me...I work from home and I can test as often as I like....

As for your vet moving in .5 increments, as Chris said many vets just don't have a thorough understanding of feline diabetes - I've had personal experiences with vets who understood little to nothing about FD and I've read way too many FB and FDMB posts about vets advising their clients to give their kitties TOO much insulin and with TOO little emphasis on testing! Unfortunately the outcome is not what you'd want!

It's not their fault. Vets are spread too thin to research and read every article about the nuances of feline diabetes - they simply do not have the time to keep up with all the literature and extensive studies and just in this group alone - hundreds of cats are undergoing treatment - as we speak by their humans who are doing a wonderful job of keeping their kitties regulated, up to and including getting them into remission.

So believe me when I say this group has more collective wisdom, knowledge and experience than 99.9% of the vets out there. Unless your vet is an endocrinologist who specializes in FD, then it's not likely they're making the best recommendation for you and Dora.

 

[Dora the Explorer]

Thanks all! Well, I went ahead and did the 1.75. I know from past experiences that one skipped dose has taken days to recover out of the higher numbers. My husband and I both work from home mostly (for now) so we can do more tests. Dora’s been crying out and looking pinpricked lately so we have been laying a little low. We will step it up. I think we should be able to skip the Libre for now. It’s only a short term info session and then we’ll be right back where we are now anyway.

I’m kicking myself for not answering the phone. We were testing Dora and I heard the buzzing but thought it was my work phone so ignored it. I’ve now purchased the Dora the Explorer ringtone and set it as her default for future calls!

But this was the only time the doctor herself called me! And I missed it! She usually delegates that to her tech . Also, this vet had a diabetic cat herself so I do trust that she’s got some knowledge even beyond what she learned in school.

so ... what happens now, Dora?!

 

[Dora the Explorer]

Did you skip last night? No PMPS, no shot?

Last night she was 390 and got her whole 2 units. This morning she was 65/61. Now 490

 

[THH & Snowcrash (GA)]

Last night she was 390 and got her whole 2 units. This morning she was 65/61. Now 490

Let's hope tomorrow's AMPS is better! Definitely looks like 2 units is too high.

 

[Sue and Luci]

Last night she was 390 and got her whole 2 units. This morning she was 65/61. Now 490

She's bouncing from hitting that low number. It's their bodies natural response to going lower than they're used to. The liver stores up glycogen (sugar) for these perceived emergencies...and when the blood glucose is lower than they're used to, it releases a lot of stored up sugars into their bloodstream. It'll clear in a while...some cats take longer than others to clear the 'bounce'...but don't worry...once she clears it you'll see... and then you'll have a different problem on your hands.

Please try to get more tests in ... then you'll have a better picture of when she's cleared the bounce and when you might want to bring out some medium or high carb food to feed her to prevent her from dropping quite so low.

 

[Sue and Luci]

Definitely looks like 2 units is too high.

I would agree with you on that...however without mid-cycle tests, it's really impossible to tell. Lantus hits it's most effective peak around mid-day...sometimes earlier, sometimes later...but start testing at 2+ so you don't miss an early drop...and test again until you see the drop starting..and then ending...

It's just really hard to tell if this drop was a one-off or indeed too much insulin. Only more tests will tell us that for certain.

 

[Dora the Explorer]

I would agree with you on that...however without mid-cycle tests, it's really impossible to tell. Lantus hits it's most effective peak around mid-day...sometimes earlier, sometimes later...but start testing at 2+ so you don't miss an early drop...and test again until you see the drop starting..and then ending...

It's just really hard to tell if this drop was a one-off or indeed too much insulin. Only more tests will tell us that for certain.

she did have one night during the week where she dropped into the 100’s but then came back up. In retrospect we should have been testing more as she may well have been low. When she was on the 1.5 she’d be in the 300s all day when we’d test her. Ugh! We just hate hurting her though. She always cries out!

 

[Wendy&Neko]

She's not just bouncing tonight, she is also high because this morning's dose was skipped. But don't worry, they do get back on track surprisingly quickly.

Are you using Neosporin on the poke spot on her ears? And a bit of pressure on the poke spot for at least 10 seconds afterwards? That'll reduce bruising and the Neosporin ointment will also help heal. Also, are you freehanding the poke or using the device?

By the way, it's entirely possible to test on the road. We had several long road trips with Neko where we'd pull over into a stop and give her a test. Plus I've tested in the car in ferry lineups, on the ferry itself. Even done shots in the lineup or on the ferry.

Good luck with the new dose.

 

[Dora the Explorer]

She's not just bouncing tonight, she is also high because this morning's dose was skipped. But don't worry, they do get back on track surprisingly quickly.

Are you using Neosporin on the poke spot on her ears? And a bit of pressure on the poke spot for at least 10 seconds afterwards? That'll reduce bruising and the Neosporin ointment will also help heal. Also, are you freehanding the poke or using the device?

By the way, it's entirely possible to test on the road. We had several long road trips with Neko where we'd pull over into a stop and give her a test. Plus I've tested in the car in ferry lineups, on the ferry itself. Even done shots in the lineup or on the ferry.

Good luck with the new dose.

thanks! She’s already dropped to 342 at +3 so that’s a nice drop. Yes to the Neosporin and pressure and freehanding. I can try to press a bit longer but she’s usually wrangling away by then!