15/2 Chico AMPS 504 +3 220; +5 169; PMPS 571

[Marina & Chico]

First time on Lantus a black value

Yesterday's thread:
https://www.felinediabetes.com/FDMB/threads/14-2-chico-amps-362-2-410-6-5-158.243094/

 

[Marina & Chico]

from the TR guidelines

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.
• Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
• Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.

I've highlighted the section that pertains to Chico at this time. This is cycle8 I would like to see where he lands when he next clears, with nadirs in the 80's and 90's you probably have a little wiggle room to take him up, if you find he trends up or just doesn't get much lower than 90. So you may hold on to this dose a little longer than 10 cycles, but you might need to push the dose up to see him shift the whole range down a touch and spend even more time in the 'healthy zone'
You just have to let the numbers be your guide.


Not necessarily, if a higher dose sees him spend longer in the lower numbers then he may end up bouncing less, hard as bounces are to ignore, they are part of the process, our focus needs to be on the nadirs.

Chico is still in very early days of his FD journey, take one day at a time

The TR protocol says we need to aim with the nadirs between 50-80, which is true we still didn't achieve with this dose. I understand we wait today to see his values and then take a decision of whether an increase is required.

The black AMPS made my heart smaller i know it is part of the process but as happy i am when i see green in a cycle as disappointed i get to see blacks. Do you think the food at +6 when he was already rising could have caused it?

What do you think about the 70g PS considering that 1 cycle worth of food is 140g?

I am trying to feed him 10g instead of 20 at +1 now to see how will he manage that.

 

[tiffmaxee]

He’s bouncing from the good values last night. When you see blue nadirs you hold the dose for at least 10 cycles. We need to wait for the bounce to clear. It can take as many as 4-6 cycles or happen sooner. Patience needed.

 

[Marina & Chico]

He’s bouncing from the good values last night. When you see blue nadirs you hold the dose for at least 10 cycles. We need to wait for the bounce to clear. It can take as many as 4-6 cycles or happen sooner. Patience needed.

Thank you for the reminder, i am very nervous when i see black numbers but rationally i understand we can't consider a single number as information, that it is the trends that matters

 

[Gill & George]

I can certainly relate to the roller coaster of emotions when you get a BG.

So you would need to hold at least today and tomorrow. It would be good to see him clear the bounce before you take him up. He's been clearing bounces although it can take up to 6 it hasn't really been taking him that long. Let's just see where he goes.

I

Do you think the food at +6 when he was already rising could have caused it?

I doubt it, it was LC, and not too late in the cycle.

What do you think about the 70g PS considering that 1 cycle worth of food is 140g?

On a cycle where I didn't need to steer that is more or less how I fed George. (75g at PS then 3 snacks of 25g).
If I needed to steer I did and didn't worry about how much I fed, I just fed what I needed to.
Does Chico need to watch his weight?

I am trying to feed him 10g instead of 20 at +1 now to see how will he manage that.

you can try and see what happens.

 

[Marina & Chico]

I can certainly relate to the roller coaster of emotions when you get a BG.

So you would need to hold at least today and tomorrow. It would be good to see him clear the bounce before you take him up. He's been clearing bounces although it can take up to 6 it hasn't really been taking him that long. Let's just see where he goes.

I

I doubt it, it was LC, and not too late in the cycle.

we will give him 2 more days before taking a decision. I will turn my patience mode ON

On a cycle where I didn't need to steer that is more or less how I fed George. (75g at PS then 3 snacks of 25g).

ok, he likes having his bigger meals

If I needed to steer I did and didn't worry about how much I fed, I just fed what I needed to.
Does Chico need to watch his weight?

Chico lost 1 kg since November (before he was diagnosed), he is now 5kg and would need to lose a bit more but at this moment we want to focus on him not gaining additional weight. Of course when we have to overfeed him, we do but we are trying to avoid it.

you can try and see what happens.

 

[Gill & George]

Chico lost 1 kg since November (before he was diagnosed), he is now 5kg and would need to lose a bit more but at this moment we want to focus on him not gaining additional weight. Of course when we have to overfeed him, we do but we are trying to avoid it.

I had the same problem with George, I focused on his diabetes, by feeding him appropriately in cycles where I didn't need to steer him. Once he settled and didn't need as much steering I was able to get him to loose slowly.
Since I swapped him to a wet food diet he does much better with his weight, it has been easier to manage, and I got him to a good weight for him, something that years on a reduced calorie kibble never managed. He's happy and satisfied with the amount of food he gets, on kibble he was always hungry.
George likes to eat and that was really helpful in his FD journey, I could rely on him eating not matter what.

He didn't spend long in black. Good to see Chico come back down.

 

[Hercule's mum]

Hi Marina, I don't know Chico's pattern well enough, but I tought I would mention that when Hercs is breaking a bounce (which seems to be every day ) his BG just continues to go down, past usual nadir. So if chico does the same, he could have gone a bit lower last night, after +6, which would explain the black....
So frustrating! But he''ll come down again!

 

[Marina & Chico]

Hi Marina, I don't know Chico's pattern well enough, but I tought I would mention that when Hercs is breaking a bounce (which seems to be every day ) his BG just continues to go down, past usual nadir. So if chico does the same, he could have gone a bit lower last night, after +6, which would explain the black....
So frustrating! But he''ll come down again!

the new cycle looks bouncy but he still got a blue, i am curious if it can be considered a bounce cycle or not

 

[Hercule's mum]

The blues is quite a drop from the black.... so let's hope he doesn't decide to bounce again!

 

[Gill & George]

the new cycle looks bouncy but he still got a blue, i am curious if it can be considered a bounce cycle or not

This morning cycle is an active cycle it starts high drops down through nadir and will probably rise into PMPS. This is not a bounce. It may not have the gentle curve we love see, but it is a curve none the less.
It looked like it might be a bounce when he started off high, but it wasn't.


A bounce is when the numbers rhigh and flat.
Am cycle of 2/13 and 2/11 were bounces high and flat, following a drop into blue/green the night before.


Unless he sees green tonight I think you could take him up to 1.5 u tomorrow morning.

 

[Marina & Chico]

This morning cycle is an active cycle it starts high drops down through nadir and will probably rise into PMPS. This is not a bounce. It may not have the gentle curve we love see, but it is a curve none the less.
It looked like it might be a bounce when he started off high, but it wasn't.


A bounce is when the numbers rhigh and flat.
Am cycle of 2/13 and 2/11 were bounces high and flat, following a drop into blue/green the night before.


Unless he sees green tonight I think you could take him up to 1.5 u tomorrow morning.

PMPS 571, should we increase to 1.5 today already?

 

[Marina & Chico]

PMPS 571, should we increase to 1.5 today already?

We shot 1.25 i know i shouldn't react to every value but black numbers make me very very upset... our poor little Chico if tonight won't be better we will go for 1.5 in the morning

 

[Gill & George]

I'm glad you held, I know it will have been hard.

I vote fore Dose increase tomorrow unless you see green tonight, I would shoot 1.5.


If he happens to give you a blue start at amps you may want to hold the dose tomorrow morning.

How is his tummy now?

 

[Marina & Chico]

I'm glad you held, I know it will have been hard.

I vote fore Dose increase tomorrow unless you see green tonight, I would shoot 1.5.


If he happens to give you a blue start at amps you may want to hold the dose tomorrow morning.

How is his tummy now?

We will see tonight the numbers... thanks for your advice

his tummy is not ideal, tomorrow we will go to the vet. The vet told me in the previous blood work Chico had slightly increased ALT indicator (dont know exact value) but kidneys were fine. Tomorrow we will do some more

 

[Gill & George]

ALT is one of the liver enzymes, George's ALT was raised at his diabetes diagnosis, at his followup it had recovered. George had probably been diabetic for a while before we realised, he lost quite a bit of weight even though he was eating.

Ask the vet for the previous results and get a copy of any new ones he does tomorrow.



If you are going to the vet in the morning you may want to hold off the increase till the evening, just o case he has a strong reaction to a new dose.

Sorry his tummy is still not right.

 

[Gill & George]

Morning, hope all goes well at the vets.

 

[Marina & Chico]

Morning, hope all goes well at the vets.

Thank you, we already have the sample prepared, we will go as soon as the morning meetings are over.