12/30 - Alphyne - AMPS 397, +8 436 - can't find good dose

[bobjoh]

(previous) 12/10 - Alphyne - 252 @ AMPS - 380 @ +8 - curve day | Feline Diabetes Message Board - FDMB

Alphyne has been needing steady dose increases. If she ends up holding a dose, she usually increases the next curve.

I've mentioned before that I'm having a tough time telling if she just has high numbers, or if she's bouncing.

Her last curve, on Sunday (12/26), saw another increase (to 3U), followed by two very low numbers. Last night's low (49) warranted a reduction, so she's back to 2.75U.

She (surprisingly) didn't bounce (much) from the low on Tuesday, but is bouncing big time from the low last night.

She had better numbers on 3U, but the lows are scary, so it seems to be too much. 2.75U didn't seem to be enough, although she had a couple of good cycles.

Since she bounces so often, and for so long, I'm at a loss. I don't know how to help her. I can't find a good dose for her, she's not getting better, and she's either super high or super low.

We are going on almost a year now. She has no underlying conditions that are showing up in blood work, and other than the diabetes and some arthritis, seems fine.

I know that ECID, and I don't get much feedback since she's probably an odd case, but can anyone offer advice? Maybe she's an exception and shouldn't have the same dose AM and PM? My vets (old and new) aren't offering up any options, and we are just spinning our wheels at this point.

Thank you in advance!

 

[Wendy&Neko]

Good catch on that 49! That's scary to see on the AT. Are you using the AT again as your meter? If so, just wondering what you are using as your reduction point. 60 is too low if you are using the AT. Even followers of Tight Regulation use 68 if using the AT.

Since 2.75 had taken her down to 75, I wouldn't have been in a rush to increase her to 3.0 units. Think about how low the dose is taking the cat in all the tests you do on that dose, not just what she does on curve day. You get quite a few other tests during the non curve day cycles, so have quite a bit of data to help with dosing decisions. If you had been following SLGS as written (and not custom), that 75 would have earned a reduction back to 2.5 units.

I don't think changing the dose AM and PM would help much, it would just disrupt the depot. With the dosing methods we use here, using the same dose AM and PM seem to work best.

One possibility is to try an insulin switch to Levemir. The action is very similar to Lantus, except delayed. So standard onset is +4 and standard nadir +8, though of course not all cats follow that. My girl was later with both. Some people find the timing doesn't work for their schedule. But it did for me and like a number of cats, found that Neko's cycles were much flatter and predictable.

 

[tiffmaxee]

Hi. Wendy typed faster than I did. It would be good if you posted more often as I dint think anyone looks at spreadsheets unless they see a condo.

 

[bobjoh]

Good catch on that 49! That's scary to see on the AT. Are you using the AT again as your meter? If so, just wondering what you are using as your reduction point. 60 is too low if you are using the AT. Even followers of Tight Regulation use 68 if using the AT.

Since 2.75 had taken her down to 75, I wouldn't have been in a rush to increase her to 3.0 units. Think about how low the dose is taking the cat in all the tests you do on that dose, not just what she does on curve day. You get quite a few other tests during the non curve day cycles, so have quite a bit of data to help with dosing decisions. If you had been following SLGS as written (and not custom), that 75 would have earned a reduction back to 2.5 units.

One possibility is to try an insulin switch to Levemir. The action is very similar to Lantus, except delayed. So standard onset is +4 and standard nadir +8, though of course not all cats follow that. My girl was later with both. Some people find the timing doesn't work for their schedule. But it did for me and like a number of cats, found that Neko's cycles were much flatter and predictable.

Yes, no vets here will work with me using anything other than AlphaTrak numbers, so I gave up and switched back.

My original vet said a reduction point of 60 (she said 80 was too high, even though it was also mentioned in the protocol she had given me), since she doesn't have any symptoms when she gets low. I think the thought process was holding her at a dose longer might keep her in an acceptable range longer, but that's not happening.

Do you think I should switch back to the 'standard' SLGS? I don't know that it would hurt as this point, since the reduced reduction point doesn't seem to make a difference anyway.

I was holding doses for about 14 days for a while, but it was said I may possibly cause glucose toxicity holding it that long, so I went back to every 7 days (or tried to).

I will ask about an insulin change! I will work from home for the forseeable future, so my schedule is very flexible. I have had some issues with my own medical stuff lately, which has thrown a curve into things a bit, but hopefully that's all behind me now!

Thank you!!

 

[bobjoh]

Hi. Wendy typed faster than I did. It would be good if you posted more often as I dint think anyone looks at spreadsheets unless they see a condo.

Thanks for that advice! I'll certainly try...I was posting a lot at the beginning of this journey...or at least more than now. But it was hard with two cats having diabetes and hard to keep the advice straight, since both cats are so different.

 

[Wendy&Neko]

Yes, no vets here will work with me using anything other than AlphaTrak numbers, so I gave up and switched back.

Are you going to the vets for dosing? If not, the type of meter you use shouldn't matter. Or you can just use the AT on curve day if that's what you show them.

A reduction point of 60 on the AT is dangerous! That's too low, though OK for a human meter. We don't know what happens to cats on a cellular level, even if they aren't showing hypo symptoms. I'd try going back to 80 on the AT if you think 90 wasn't working for her.

 

[bobjoh]

Are you going to the vets for dosing? If not, the type of meter you use shouldn't matter. Or you can just use the AT on curve day if that's what you show them.

When the vet asks me to show them my spreadsheets (I keep track of the one online and have an excel sheet for the vet), they get PO'ed and ignore the measurements that aren't on an AlphaTrak. In any case, it works for us, and I'm comfortable with it now. We've been back on the AT2 since April.

Thanks, I'll go back to 80. My vet was saying (when I was reducing at 80), that I was reducing too much, since she never showed any clinical symptoms.

Appreciate it.

 

[Heather38]

My original vet said a reduction point of 60 (she said 80 was too high, even though it was also mentioned in the protocol she had given me), since she doesn't have any symptoms when she gets low.

Woah! I'm surprised the vet said that. Every cat is different of course, but my cat had a sympotmatic hypo at 59 on an AT meter. His head started tilting to the side and he started to lose balance and he legs got weak all of a sudden. Luckily I was home and noticed it right away and he was still with it and wanted to eat. I would be so scared now if I saw him hit close to 60 again.

 

[bobjoh]

Woah! I'm surprised the vet said that. Every cat is different of course, but my cat had a sympotmatic hypo at 59 on an AT meter. His head started tilting to the side and he started to lose balance and he legs got weak all of a sudden. Luckily I was home and noticed it right away and he was still with it and wanted to eat. I would be so scared now if I saw him hit close to 60 again.

My vet always said 'how is she doing clinically' every time Alphyne had a low number. Since she was always "fine" clinically, I suppose that what drove the decision. She meows at me, thank goodness, when she gets low, so she always gives me a heads up. Each time I had reduced in the past, at 80 or 90, I was told that I "needed to not just pay attention to the numbers, but look at how she's doing clinically".

My new vet isn't much better sadly, and is horrible about getting back to me; I can't rely on any of the vets in the area, apparently. I've been trying to use a mix of the vets advice and the advice I get here, since Alphyne doesn't seem to respond to anything like another cat would, but the advice I get here is consistently better, anyway, so my approach will definitely change.