Nico - link to new thread in comments

Emily Tuomey

Emily Tuomey

Active Member
So to catch folks up, last night Nico’s PMPS was quite high, in the 400s, after a token dose in the morning and a day of lower numbers. He was great overnight and came in with a +10 of 297. About an hour and forty five minutes later he had dropped to 226 for his AMPS. I did give him a full dose of 2.25u as advised. I guess my question is, is it normal to see a drop from a +10 or +11 to AM/PM Pre-Shot numbers? What causes that? It’s new for Nico. Just curious.

Previous thread(s): https://www.felinediabetes.com/FDMB/threads/nico-1-5-new-thread-link-in-comments.240600/

@Deb & Wink @Shelley & Jess @JanetNJ
 
Emily Tuomey said:
So to catch folks up, last night Nico’s PMPS was quite high, in the 400s, after a token dose in the morning and a day of lower numbers. He was great overnight and came in with a +10 of 297. About an hour and forty five minutes later he had dropped to 226 for his AMPS. I did give him a full dose of 2.25u as advised. I guess my question is, is it normal to see a drop from a +10 or +11 to AM/PM Pre-Shot numbers? What causes that? It’s new for Nico. Just curious.

Previous thread(s): https://www.felinediabetes.com/FDMB/threads/nico-1-5-new-thread-link-in-comments.240600/

@Deb & Wink @Shelley & Jess @JanetNJ
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Could have just had some food wear off... Or he was active. Activity and exercise lowers numbers. Make that cat play. Lol
 
JanetNJ said:
Sorry he isn't feeling well. He's not constipated is he? Is he eating ok?
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Not constipated. Appetite is good. He’s eaten everything put in front of him today. He just gets that “I don’t feel well, mom” that all babies get when they’re sick look. (Adults definitely get that look too— working in pediatrics you get trained to see it, without them having to tell you verbally) He is laying with me, so at least he’s being social, inactively, and not hiding. Just hoping that now two usual (2.25u) doses will bring him back and kick that bounce to the curb. What are your thoughts on keeping tabs on him overnight? I think maybe just somewhere in that mid..
 
Emily Tuomey said:
Not constipated. Appetite is good. He’s eaten everything put in front of him today. He just gets that “I don’t feel well, mom” that all babies get when they’re sick look. (Adults definitely get that look too— working in pediatrics you get trained to see it, without them having to tell you verbally) He is laying with me, so at least he’s being social, inactively, and not hiding. Just hoping that now two usual (2.25u) doses will bring him back and kick that bounce to the curb. What are your thoughts on keeping tabs on him overnight? I think maybe just somewhere in that mid..
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I'm glad to see the numbers came down a bit overnight.
 
That black last night looks like a "high before the break".
Late PM cycle 01/04 thru to AMPS 01/05 looked like he was trying to clear the bounce but didn't quite make it - by 01/05 AM+6 he shot back up and by PMPS he was black.
Just mentioning it so you can keep an eye out for that same sort of pattern in the future if it happens again. Nico sure is on a mission and keeping you on your toes! Good catch last night Em.

Definition of High before the break as posted by Marje and Gracie taken from this thread https://www.felinediabetes.com/FDMB/threads/slgs-method.228857/#post-2562710

“High before the break” is often missed and thought by many to be a sign more insulin is needed. But you have to look at the clues.
  • He was bouncing
  • He was due to clear the bounce
  • His BG was wobbling a bit like it might be clearing but then the numbers shot way up.
  • BG Starts down. Sometimes it comes down much faster than he is. I’ve seen it go from 500 to 40s in one cycle.
Still, the above pattern is classic high before the break. One note: sometimes members will see a high number out of nowhere and might suspect that is the high before the break but you have to have the entire pattern above, not just a high number from seemingly nowhere. That could be less absorption, loss of duration, etc.
 
Shelley & Jess said:
That black last night looks like a "high before the break".
Late PM cycle 01/04 thru to AMPS 01/05 looked like he was trying to clear the bounce but didn't quite make it - by 01/05 AM+6 he shot back up and by PMPS he was black.
Just mentioning it so you can keep an eye out for that same sort of pattern in the future if it happens again. Nico sure is on a mission and keeping you on your toes! Good catch last night Em.

Definition of High before the break as posted by Marje and Gracie taken from this thread https://www.felinediabetes.com/FDMB/threads/slgs-method.228857/#post-2562710

“High before the break” is often missed and thought by many to be a sign more insulin is needed. But you have to look at the clues.
  • He was bouncing
  • He was due to clear the bounce
  • His BG was wobbling a bit like it might be clearing but then the numbers shot way up.
  • BG Starts down. Sometimes it comes down much faster than he is. I’ve seen it go from 500 to 40s in one cycle.
Still, the above pattern is classic high before the break. One note: sometimes members will see a high number out of nowhere and might suspect that is the high before the break but you have to have the entire pattern above, not just a high number from seemingly nowhere. That could be less absorption, loss of duration, etc.
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This is great information to have. I’d be lying if I said I hadn’t thought that maybe his numbers yesterday would earn him a dose increase (back up to 2.5u). Clearly it’s good I/we didn’t jump the gun on that. I’m still kicking myself for missing that alarm to get a +6 from him during that PM cycle, but that being said I’ve got a watchful eye on him today. Will start with a +3, in a little over an hour, just to make sure he’s still doing okay. My inclination is he will be just fine.
Shelley & Jess said:
Nico earned another dose reduction last night. New dose 2.0u. Please keep a very close eye on that cycle today if you already shot.
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Will plan for 2.0u tonight, unless something changes. I’ll check back in soon!
 
Shelley & Jess said:
That 50% drop 01/05 PM+3 was the early warning. It's why I'll always recommend those early cycle tests between +2 & +3 regardless of the PS.
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I guess it’s a good habit to get in to. I just hate poking him like 8-10x per day, especially when his ear is still a little sore. I just took a +2.5 and he’s at 236. Not sure what that means as far as what’s to come a little later in the day today.. thoughts? I’ll be sure to get another read in a couple hours to see where he’s at, hopefully he does okay; he has a strong tendency for higher numbers, not lower, so my guess is he will stay out of hypo range today.
 
We are on high alert around here.. (though again, I’m sure he will be totally normal come evening. And by normal I mean, ~200 pre-shot.) +4.5, 51. We just played, he had lunch and some protein treats, now he’s grooming so behavior is a-ok. Just keeping a watchful eye, as his nadir is usually +6ish. I’ll grab another test then, and try not to be totally distracted by what is happening in DC at the moment. Crazy!
 
When a cat's BG level drops particularly low, then a bounce is likely to happen. I think that is why Nico is rising at +10.

After that low last night, down to that BG of 39, and the lows for today, I think you want to reduce the dose. Maybe not by a lot. But a 0.25U dose reduction is in order. So yes, down to 2U is what you want to do. Nico EARNED that reduction. With both the low from last night, and the low of 51 from today.

You don't want to dose based on the bounce Nico may have after a low. I know it's difficult, and your instincts are saying to keep the higher dose. But you have to overcome those instincts and base your decisions on the dosing based on the nadirs or lows that Nico gets on a particular dose.

BG numbers in the reds and blacks, almost always indicate a reaction to a low and those high numbers are saying Nico bounced.

I don't think we "jinxed" Nico. I think his body still needs more time to adjust to those lows.

In the beginning, Nico was running mostly in the blacks and reds, because you had not found that "breakthrough" dose, that would bring his BG numbers down into a better range, into the pinks, and yellows. But once you started to be more aggressive with the testing, switched to the MPM dosing protocol, and found that "breakthrough" dose, Nico has been doing so, so much better.

It hasn't been a super smooth process for Nico, but with a diabetic cat it often isn't smooth, and there will be more frequent ups and downs.

We focus on the BG numbers a lot here, when we make recommendations. But you are there to observe his behavior and can see trends in his eating, drinking, peeing, etc. So you take those factors into consideration, and look for trends, and not focus on a single cycle or a single day before you decide to make a change. But there are certain safety safeguards that do need to be paid attention to, such as lows < 50 mg/dL. "Feed the 40's."

So hold that lower 2U dose for a few cycles, if at all possible. I'm even seeing another reduction in Nico's near future!:)

:bighug::bighug::bighug:
 
Deb & Wink said:
When a cat's BG level drops particularly low, then a bounce is likely to happen. I think that is why Nico is rising at +10.

So hold that lower 2U dose for a few cycles, if at all possible. I'm even seeing another reduction in Nico's near future!:)

:bighug::bighug::bighug:
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You called it. PMPS, 335. SIGH. I’m tired.. :(:confused::oops: 2.0u given.
 
I'd take another dose reduction for Nico, after that BG of 63 at +6 today, 1/8/21.
So down to 1.75U dose.
Hope you see this suggestion, before the PM (evening) shot.
 
Deb & Wink said:
I'd take another dose reduction for Nico, after that BG of 63 at +6 today, 1/8/21.
So down to 1.75U dose.
Hope you see this suggestion, before the PM (evening) shot.
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I did actually! 303 for the poor guy’s PMPS, but 1.75u given/started this evening despite. Nervous for what high numbers that dose reduction will bring, but I’m trying to be cautiously optimistic...

TGIF, guys!
 
@Deb & Wink @Shelley & Jess @JanetNJ hoping you guys can weigh in on this for me today. We had a GREAT number for AMPS (154), which I was super happy about. But now we are showing numbers in the black zone (again), and it’s only +4 (540) :banghead:. I’m incredibly worried about what’s to come for the rest of today.. :nailbiting: What is up with him?? I did second guess my shot this morning, but it wasn’t wet so thinking it wasn’t a fur shot. (And, I did a repeat test to rule out a bad strip too.) But what else could/would cause him such a steep increase in that short of a time frame?? At this rate by PMPS he will like unreadably high for sure. Just sucks. I don’t want him to be miserable (though his behavior is great at the moment, he’s romping through the house currently!) I’ll look for your responses in a bit.
 
Still black. Very, very black. PMPS, 559. Was secretly wishing he’d surprise us tonight. Not so. I’m sad for him. :oops: He’s not acting like he’s feeling bad though, aside from a tad more thirst this evening. Hope he’s gonna come back down tomorrow. I’ll do one more test before bed. Thanks @Deb & Wink @Shelley & Jess @JanetNJ.
 
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