8/17-18 Fred PMPS 506, +1.5 542, +5 265, +6 354

[Purrberry]

https://www.felinediabetes.com/FDMB/threads/8-17-fred-amps-402-5-5-191-8-81.251547/#post-2838300

Along with the excitement yesterday, Fred really freaked me overnight. He flew up, as expected, with breakneck speed, but what then really scared me was a nearly 300 point drop only 3.5 hours in. Tested twice. Then up 100 points in one hour. (thank God, frankly) Isn't that...extreme...for a cat on Levemir? Especially the drop. I couldn't believe it given the bounce.

I reduced his dose, and everything else about the nighttime routine was the same. I try not to tag you, @Wendy&Neko, too much, as there are many cats that need help. But I was wondering if you had some insight. I did give 18% carb at +5, but normally that barely makes a dent, let alone bring him up 100 points.

I also have to be out all day tomorrow.

 

[Wendy&Neko]

Sorry to be late to answer. But I would have stuck with 4.25 units tonight. The lowest he got on 4.5 units was 81, which does mean a reduction with SLGS, but is still in safe territory. You didn't need to "drain the depot". That's a technique only used for cats on higher doses than Fred now is.

To answer the "why so high?" last night at +1.5 - he hadn't onset yet and was still on his way up from the previous cycles shot. You gave 18% at the 81, but it was towards the back half of the cycle, and likely much more HC than you needed to give. The goal of giving HC is to pop them up no more than 30-40 points, though given how high Fred was (81) and how late in the cycle (when the insulin effect is wearing off), you could have stuck with LC. So what happened is the HC shortened the duration and his numbers skyrocketed until the next insulin shot onset. You also didn't need to give the 18% given when he is in yellow. You can see it jumped him up 100 points, when all you wanted was to get him to coast or slow the drop. LC would have been enough. And think tsp, not Tbsp.

The other thing to think about, when you see him in nice high green/low blue, you want him to spend as much time there as possible, so his body gets used to those numbers, and teaches him not to bounce as much.

 

[Purrberry]

No worries about the lateness. I appreciate you getting back to me.

Well, if there's good news, I'm glad to know Fred isn't as "high dose" as he once was! ;-)

Almost immediately, I realized I didn't need to give Fred HC yesterday when he hit the 81. I should have stuck with regular. But I knew he had about an hour more to drop, generally, and I had hoped it would help him surf.

As for his overnight yellow and the HC, that's more my question. The drop. I was/am very concerned about the very significant nearly 300 drop in only 3.5 hours of time. I'm trying to figure why THAT happened. It just seems very unusual. My best theory is that when Fred goes lower than he's used to, he becomes more sensitive to insulin for a couple of cycles afterward. I know it's said that only happens in systematic hypos, but Fred seems to react this way whenever he drops "low". So perhaps I should have just anticipated that and adjusted his dose.

You also didn't need to give the 18% given when he is in yellow. You can see it jumped him up 100 points when all you wanted was to get him to coast or slow the drop. LC would have been enough. And think tsp, not Tbsp.

As for this, my thinking was, again, "Holy cow....he's completely tanking and I don't know if he'll stop with possibly 4 hours to go.". I wouldn't ever normally give HC in yellow. Fred is not, normally, carb sensitive. I've had long nights where I pump him full of HC and Karo and it nary raises him 10 points. So I was shocked (but relieved) to see him come up so much. But it couldn't have been from just the HC. Maybe a bounce from that steep, quick drop?

Or maybe I just chalk it up to a wonky day. *sigh* It's so scary and I'm exhausted by it.

 

[Wendy&Neko]

But I knew he had about an hour more to drop, generally, and I had hoped it would help him surf.

As a rule of thumb, when they first hit green, try LC first to help them surf.

'm trying to figure why THAT happened. It just seems very unusual. My best theory is that when Fred goes lower than he's used to, he becomes more sensitive to insulin for a couple of cycles afterward. I know it's said that only happens in systematic hypos, but Fred seems to react this way whenever he drops "low". So perhaps I should have just anticipated that and adjusted his dose.

No, what happened is you gave HC and shortened the duration of the AM insulin dose, meaning his numbers jumped up at the end of the cycle. Then he onset and came down to a more than safe number. Can you give some examples of where you think he's become more sensitive to insulin? I can't see them. All I see is very brief flirtations with normal numbers, followed by bouncing.

 

[Purrberry]

Sorry for the delay. I was out all day yesterday.

Can you give some examples of where you think he's become more sensitive to insulin?

I'll have to go through to find specific examples, but, I think the PM cycle on 8/17-18, the one I started the thread about, is a great example. He had a massive bounce which should have kept him high, was given a reduced dose, and still, he flew down 286 points in 3.5 hours. Its' not so much what the number ARE, per se, (I know they were fine) it's how quickly/strongly the insulin hit him.

That was his biggest and fasted drop to date.

 

[Wendy&Neko]

I don't see "sensitive to insulin" on the PM of 8/17-18. Like I said, I see shortened duration from the HC given the cycle before raising the numbers, then him dropping to roughly where he might have been if you hadn't given HC. There is a difference between bouncing (which can last several cycles) and shortened duration which is essentially the insulin from that cycle wearing off early and causing the back half of the curve to skyrocket up. That only lasts the one part cycle.

One other thing I'll caution, we find it's much better to be consistent on dosing. Dosing has been all over the place the last couple of days. Make your changes based on nadirs or low low the dose takes the cat, ignore the preshot values. Reducing the shot while you are away doesn't always get the effect you want, due to the nature of the depot. That means what you shot the cycle before has an influence on the following cycle.

I noticed your comment about having a hard time with the 0.25 unit doses. Have you looked into getting calipers? Dosing with calipers It's an option that really helped me.

 

[Purrberry]

So here's where I find this confusing.

If this is the case:

You didn't need to "drain the depot". That's a technique only used for cats on higher doses than Fred now is.

Then how can this be the case?:

Reducing the shot while you are away doesn't always get the effect you want, due to the nature of the depot. That means what you shot the cycle before has an influence on the following cycle.

I find these two statements to be contradictory.

Dosing has been all over the place the last couple of days.

I have to take exception to this. Fred earned a reduction, causing a necessary reduction in dose. I then lowered his dose the PM cycle before I knew I was going to be out all day, (to not have the previous dose affect the next cycle) and gave that same dose in the AM cycle I was going to be gone. Then we were right back on track that evening. I don't feel that constitutes as "all over the place". While I do understand and know that consistency is of course best, sometimes, life happens. I do what I feel is necessary to keep Fred safe.

When I am gone, Fred eats much less, causing his levels to drop a great deal. I found this out the hard way. So even if I am just gone for one cycle, I will always "vacation dose" him. I will always, always err on the side of caution when it comes to the threat of a hypoglycemic event. This is for Fred's safety, which is of utmost importance to me, and my sanity. If it blows a few cycles, so be it. It is extremely challenging to balance everything when dealing with a cat with huge glycemic variability.

I have looked into calipers, but it creates a complication for anyone else who might care for him.

 

[Wendy&Neko]

Calipers make it easier if you have multiple people dosing the cat, like I did. It's one way to ensure consistency between people.

All I can tell you about dosing is what I see on the spreadsheet. That plus the effect of the depot means shooting a one time lower dose does not always achieve what you want it too on that particular cycle. You don't need to "drain the depot" because it's a technique used only with cats that have higher depots than most cats here do. And it's a technique used to influence more than just a single cycle.