? 3/2 - Wally - AMPS=433, +4=435,+7=453, PMPS=444, +2=407 Is he insulin resistant?

Ginger Cat

Ginger Cat

Member Since 2017
It's so frustrating with this amazing kitty. Every time he gets in the blue/green numbers he bounces. If I up his dose to 2.25 units, he hypos. If I go down to 1.75 he stays high. If I keep him at 2 units, as he is now, he'll have some great nadirs and then bounce.

I know Chris mentioned something about this to another member of the message board. Chris - can you elaborate on this condition and if there's any way to 'break' the cycle? We've been doing the sugar dance for 3 years.

Thanks.

Gita
 
Definitely getting insulin resistance for a few days after each bounce. That's to be expected.

I can't see the spreadsheet for the 1.75 dose, so it could just be he needs a lower dose now.

But in your position I think I would wait for another day that starts under 300 at preshot, lower dose to 1.85 or so, and try to hold it there for at least 4 days.
No point lowering until that latest bounce is cleared. Every time he bounces, he becomes very resistant.

If later on you see the bounces begin again at the lowered dose, try lowering another 1/8 unit after the bounce clears.
 
Would you consider using a human meter? That way as a long term diabetic you could only reduce if 3 times in the 40’s or one under 40. Dropping to 1.75 after the under 68 was too big a drop.
 
Marje and Gracie said:
Steve...it’s on the 2020 tab so just click on that :)
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The 1.75 dose is on the 2021 spread sheet, actually for 1/27 - 1/29/21.
tiffmaxee said:
Would you consider using a human meter? That way as a long term diabetic you could only reduce if 3 times in the 40’s or one under 40. Dropping to 1.75 after the under 68 was too big a drop.
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With the AT2, anything under 69 is considered hypo and he'd actually gone down to 47. I had debated going just back to 2 but looking at his chart, he wasn't doing that great at 2 so I wondered if going to 1.75 would be an alternative. Sometimes, too much insulin results in wacky numbers.
 
Ginger Cat said:
The 1.75 dose is on the 2021 spread sheet, actually for 1/27 - 1/29/21.

With the AT2, anything under 69 is considered hypo and he'd actually gone down to 47. I had debated going just back to 2 but looking at his chart, he wasn't doing that great at 2 so I wondered if going to 1.75 would be an alternative. Sometimes, too much insulin results in wacky numbers.
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I saw that but we take a .25 reduction and you took a bigger one. You have been on 2.0 and not seeing green but once.
 
Gita:

I agree with Elise with regard to how you're taking reductions. I'd like to step back for a minute with a few thoughts.

It looks like you're still following TR. If so, one point to consider is that Wally is a long term diabetic. Reductions occur at a lower number than with a cat that's within a year of diagnosis. On a human meter, the dose reduction point drops from 50 to 40. I'm honestly not sure what that would be in AlphaTrack terms but you need to consider that the point where you reduce the dose is now lower than previously. I would encourage you to go over TR and evaluate the dose every 6 cycles.

I think Wally is bouncing. Any time you see blue or green numbers, he then spikes into the 400s or higher. The trick here is to try to get as much insulin into Wally as you safely can while at the same time, try to prevent a dose reduction by steering the numbers with food. Ideally, he will start to spend more and more time in lower numbers and his pancreas will stop panicking. For example, on 1/27 during the PM cycle, when you saw the drop from PMPS of 372 to a +2 at 155, it was loud signal that numbers were heading rapidly down. It would have been a good time to test and intervene at +3 (ore even +2.5) so numbers didn't have a chance to drop into the 40s. Instead, you'd want to keep his numbers in the higher greens/lower blues.

There is an inherent problem with holding on to a dose that isn't getting your cat into more desirable numbers. Holding the dose can result in glucose toxicity developing. It's a horrible term for basically saying that your cat's body starts to treat higher numbers like the new "normal."

Another option is to consider holding the dose until Wally drops below 68 (since you're using an AT meter) during 3 separate cycles. This is a variation on TR that can be helpful for longer term, bouncy kitties.
 
Steve & Jock said:
Definitely getting insulin resistance for a few days after each bounce. That's to be expected.

I can't see the spreadsheet for the 1.75 dose, so it could just be he needs a lower dose now.

But in your position I think I would wait for another day that starts under 300 at preshot, lower dose to 1.85 or so, and try to hold it there for at least 4 days.
No point lowering until that latest bounce is cleared. Every time he bounces, he becomes very resistant.

If later on you see the bounces begin again at the lowered dose, try lowering another 1/8 unit after the bounce clears.
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You're saying that I would continue to REDUCE the dose if he bounces?
 
Ginger Cat said:
The 1.75 dose is on the 2021 spread sheet, actually for 1/27 - 1/29/21.
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Thank you. I thought he was looking for a more historical view since he said he couldn’t see the 1.75u.

Ginger Cat said:
With the AT2, anything under 69 is considered hypo
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This is not correct. The reduction point under TR for the AT is below 68. That does not, in any way, imply that 68 or 67 is a hypo BG. For human meters, we definitely need to pay attention when the BG gets into the 40s but there is no equivalent on the AT. And because ECID, some cats drop into the 20s on a human meter with no clinical hypo symptoms while others see some wobbliness in the 30s. Having said that, it is very important to stay on top of BGs that fall below the reduction numbers.

Insofar as dosing advice, I agree with Sienne 100%. I would certainly not take the dose down until he earns a reduction as Sienne and Elise have mentioned. He is not seeing insulin resistance after each bounce. He’s just not clearing the bounces quickly.

The best advice is what Sienne has said: test by +2 and if the BG is coming down, you need to manage the curve with food (perhaps a higher low carb food) to slow it down and flatten it out. Once you get him flatter, than it might be possible to increase the dose but...baby steps.
 
Sienne and Gabby (GA) said:
Gita:

I agree with Elise with regard to how you're taking reductions. I'd like to step back for a minute with a few thoughts.

It looks like you're still following TR. If so, one point to consider is that Wally is a long term diabetic. Reductions occur at a lower number than with a cat that's within a year of diagnosis. On a human meter, the dose reduction point drops from 50 to 40. I'm honestly not sure what that would be in AlphaTrack terms but you need to consider that the point where you reduce the dose is now lower than previously. I would encourage you to go over TR and evaluate the dose every 6 cycles.

I think Wally is bouncing. Any time you see blue or green numbers, he then spikes into the 400s or higher. The trick here is to try to get as much insulin into Wally as you safely can while at the same time, try to prevent a dose reduction by steering the numbers with food. Ideally, he will start to spend more and more time in lower numbers and his pancreas will stop panicking. For example, on 1/27 during the PM cycle, when you saw the drop from PMPS of 372 to a +2 at 155, it was loud signal that numbers were heading rapidly down. It would have been a good time to test and intervene at +3 (ore even +2.5) so numbers didn't have a chance to drop into the 40s. Instead, you'd want to keep his numbers in the higher greens/lower blues.

There is an inherent problem with holding on to a dose that isn't getting your cat into more desirable numbers. Holding the dose can result in glucose toxicity developing. It's a horrible term for basically saying that your cat's body starts to treat higher numbers like the new "normal."

Another option is to consider holding the dose until Wally drops below 68 (since you're using an AT meter) during 3 separate cycles. This is a variation on TR that can be helpful for longer term, bouncy kitties.
Click to expand...
Whenever he tests low, I give him food to bring his numbers up. I tend to give him about 1 Tb of FF after every test, regardless of the number because he's usually asking for a snack. Could that be contributing to his consistently high readings? I know that we're advised to feed as needed or as they ask.
 
You definitely want to give food if numbers are low. What I was suggesting is trying to catch the numbers before they are low and using food to prevent a dose reduction. Using the numbers from 1/27, I would have given some LC food at +2 and then tested at +2.5. If numbers were continuing to drop, I'd keep using food to try to prop up the numbers. The more time Wally spends in better numbers the more his pancreas and liver will get used to those numbers.

If you look at Gabby's spreadsheet on 7/11/2014, I intervened at +1 and thereafter.
 
Ginger Cat said:
I tend to give him about 1 Tb of FF after every test, regardless of the number because he's usually asking for a snack.
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I would probably avoid doing this in the latter part of the cycle, as that can make his numbers come up by PS, and ideally we want to avoid this. Of course if he is low you may need to feed.
George would demand a snack when I tested, in the latter part of his cycle he got some freeze dried pure turkey/chicken/salmon treats.
 
Gill & George said:
I would probably avoid doing this in the latter part of the cycle, as that can make his numbers come up by PS, and ideally we want to avoid this. Of course if he is low you may need to feed.
George would demand a snack when I tested, in the latter part of his cycle he got some freeze dried pure turkey/chicken/salmon treats.
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I just got samples of Dr. Elsey's and already use freeze-dried chicken and Young Again Zero Carb Dry as a treat after testing so I'll use one of them during the latter parts of his cycle.
 
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