Teja AMPS 400, +1 310, +1.5 290

[Malia]

https://felinediabetes.com/FDMB/threads/05-13-teja-400-amps.289958/#post-3178998

That was yesterday's post. Forgive me if I am doing this incorrectly, I am learning.

So Teja is coming off of a bounce and trending downward. I am trying to slow her decent a bit with food. At this point, she is so used to being high that any trend downward into the lower 200s causes a bounce back up. I was advised to try a teaspoon of food every hour after her shot for the first 4 hours, so I am trying this. I have given her a bit more than a teaspoon, about 2 teaspoons every 20 to 30 minutes.

She has Royal Canin canned PR which is her lowest carb food, Hill's RX canned d/d which is her next higher carb and Hill's RX canned tuna stew k/d which I think is the highest carb content. the k/d isn't preferrable as it is something she has sensitivities to, but I do have it and she does like it

I am giving her teaspoons of food, but it does take her typically a couple of hours for her food to start to do anything. So here we are, trending downward and I am terrified.

Her internal med doc wants her at 2.5 units twice daily and advised me of this, this AM after I had given her the morning shot of 2.75 units.

Please give any advise you have. I just don't want her to get too low so it bounces back high again. I know the bounce is part of getting normalized, but this is really the first drop that I am educated on that with and am trying to get Teja through it the best we can.

 

[Wendy&Neko]

Teja is still bouncing. Bounces can take up to six cycles to resolve. I don't see her coming off the bounce yet. She's still in high numbers. Numbers can wobble around during a bounce. I'd expect to see numbers in the 100's or blues when she's ready to ditch the bounce.

By our dosing methods, your dose would be 2.75 units. Many vets aren't used to dealing with 0.25 unit changes.

 

[Malia]

Teja is still bouncing. Bounces can take up to six cycles to resolve. I don't see her coming off the bounce yet. She's still in high numbers. Numbers can wobble around during a bounce. I'd expect to see numbers in the 100's or blues when she's ready to ditch the bounce.

By our dosing methods, your dose would be 2.75 units. Many vets aren't used to dealing with 0.25 unit changes.

Hi Wendy, I actually gave her a lot of food today to slow/stop the decent down. If she goes into the blue numbers she will just bounce right back up over 400. My goal today was to feed her through the downward movement so she doesn't go that low, but is lower than she has been.

Any time in the past that she has gone into the blue or green numbers, she doesn't stay. She rockets back up to high. Her BG has been high so long that blue and green number can cause her to bounce. The sudden drop in BG makes her restless and miserable.

So the goal today was to get her between 300 and 200 and let her see that as a new normal and hopefully slowly bring her down to the blues and greens.

Maybe I am misunderstanding how best to do this. Please correct me if I did wrong today.

 

[Wendy&Neko]

If she goes into the blue numbers she will just bounce right back up over 400.

Bouncing from blues is not a bad thing. The way cats get over bouncing is to get used to lower numbers. Piling carbs on them to prevent low numbers will ensure she doesn't get used to lower numbers and will keep on bouncing for longer.

Getting them used to slightly lower numbers will not help prevent bouncing. You aren't the first to try it. Bouncing is a completely normal reaction from cats, especially those recently diagnosed.

In addition, her body will become used to higher numbers and you risk glucose toxicity. It's not a great name, but it means her body gets used to higher numbers and you have to add even more insulin to get over it.

 

[Malia]

Bouncing from blues is not a bad thing. The way cats get over bouncing is to get used to lower numbers. Piling carbs on them to prevent low numbers will ensure she doesn't get used to lower numbers and will keep on bouncing for longer.

Getting them used to slightly lower numbers will not help prevent bouncing. You aren't the first to try it. Bouncing is a completely normal reaction from cats, especially those recently diagnosed.

In addition, her body will become used to higher numbers and you risk glucose toxicity. It's not a great name, but it means her body gets used to higher numbers and you have to add even more insulin to get over it.

Wow, really? Oh geez, so much to learn. I am not going to lie, blue numbers are terrifying to me. And it just happens so quickly, she goes from 200 to less than 100 in an hour. And I am just supposed to let that happen and hope that she doesn't go hypo? It takes 2 hours for any food interventions to work for her, so the whole idea of getting into the blue numbers just terrifies me. So please, please tell me that I am supposed to let her get to the blues and I will do it. I am just so terrified. So very terrified. She is the light of my life and I am so scared to lose her.

 

[Wendy&Neko]

How did you find out it takes 2 hours for food interventions to work? Typically extra carbs work within 20-30 minutes.

 

[Malia]

How did you find out it takes 2 hours for food interventions to work? Typically extra carbs work within 20-30 minutes.

It seems that she has a slow metabolism. It just seems that when she eats, it takes 2 hours for any changes to register from the food that she eats. I have been watching her BG after eating. Could it be that carbs don't affect her as quickly because she has glucose toxicity or because she has more carbs in her diet due to the foods she eats?

She is starting to trend lower. She is at 218 and it is 3 hours before her next shot. I am starting to get nervous. I have never done a shot with her this low.

 

[Malia]

How did you find out it takes 2 hours for food interventions to work? Typically extra carbs work within 20-30 minutes.

Hello again Wendy, I am hoping you may be able to guide me. Teja is now running in the blue numbers and steadily decreasing slowly. In an hour and a half, it will be time to give her a PM dose of insulin. I am nervous about this. We are still really unregulated and learning what insulin does for Teja. And it is the evening, time to sleep, but our numbers are trending lower. In reading the sticky on dosing methods, I saw this and wanted to get your thoughts on this:

"
How to handle a lower than normal preshot number:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

• Below 150 mg/dl (8.3 mmol/L), don't give insulin.
• Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
  • a.) give nothing
  • b.) give a token dose (10-25% of the usual dose)
  • c.) feed as usual, test in a couple of hours, and make a decision based on that value
• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.

"
Right now, she is between 150 and 200. I don't know where she will be in an hour and a half, but should she be right where she is or lower, I am not sure what to do. Even the "above 200 but below the cat's normal pre-shot value" could fit for this as between 250 and 200 is way lower than most of her preshot values. So, I am not sure what to do. I would like some advise. As it says here, there is not hard and fast rule, but this is only the second time that PM values are lower than usual. Any advice would be appreciated greatly.

 

[Wendy&Neko]

I see you haven't shot yet. What you could do is stall. That means waiting 1/2 hour - without feeding, and see if she starts trending up again. Thankfully she's seem to be flat between +11 and +12. If you do decide to skip, please put NS or Skip in the Units column so we know that's what you did. You are new enough that a skip is an option.

You have shot 223 before, just above 200 is within 10% of that. Which is well within meter margins of error.

It just seems that when she eats, it takes 2 hours for any changes to register from the food that she eats.

You night want to mark the + times that you give karo or food. I looked at her spreadsheet, specifically 4/30 at AM+11 and 4/28 AM+8. The spreadsheet says you gave karo when she got low and both those times she had zoomed up by the next spreadsheet entry, so one hour later. So I'm not seeing the 2 hours delay.

but this is only the second time that PM values are lower than usual.

Maybe they are becoming the new normal. That's a good sign by the way.

 

[Malia]

I see you haven't shot yet. What you could do is stall. That means waiting 1/2 hour - without feeding, and see if she starts trending up again. Thankfully she's seem to be flat between +11 and +12. If you do decide to skip, please put NS or Skip in the Units column so we know that's what you did. You are new enough that a skip is an option.

You have shot 223 before, just above 200 is within 10% of that. Which is well within meter margins of error.

You night want to mark the + times that you give karo or food. I looked at her spreadsheet, specifically 4/30 at AM+11 and 4/28 AM+8. The spreadsheet says you gave karo when she got low and both those times she had zoomed up by the next spreadsheet entry, so one hour later. So I'm not seeing the 2 hours delay.


Maybe they are becoming the new normal. That's a good sign by the way.

Hello Wendy, thank you so much for your help with this! How do you do the quotes? I am learning how to do all of this.

I did decide to go with no shot for this PM. I don't like it, but I don't want to change the times of her shots and I read too late what you had suggested. To wait a half an hour and not feed. I fed her at the normal preshot time and she ate a good amount.

"So I'm not seeing the 2 hours delay." I took a look at my libre app to check where I was feeding her and when the glucose goes up. What I am seeing is her glucose goes up between 30 and 60 minutes. I think my 2 hour finding was from when we first started with insulin and had a full dose of prednisolone and she was still eating dry food. A lot has changed since then.

I also wanted run something by you. In reading the starting dosing for the "Start Low and Go Slow" method, when getting started, it is suggested that you start with a unit and keep it for a week. Teja hasn't done any of this. There has been a huge change when it comes to her steroid. We have reduced her amount from 5mg once daily, to 2.5mg twice daily, and now she is at 1mg twice daily. Eventually, we will taper her off of the steroid entirely, but we are doing that slowly. The steroid was inflating her glucose numbers huge and we were up to 3 units due to that inflation. Now that we are down to the 1mg twice daily, I feel that the 2.75 units may be too much since it was based on the full dose of steroid. Can I do a lower dose for Teja, say something like 2 units, and hold that dose for a week, then do a curve to see if an increase is needed? Can I do this so I can stop guessing and build towards the right dose? My vet has had us changing doses. We were at 2 units, for a while. Then on 5/7, she increased it to 2.5 units, then increased it to 3 units on 5/9. I don't feel that the increases were given enough of a chance to make any changes. And Teja's glucose does that wonky thing when you increase it, it goes higher. So I would like to do a restart on my start low and go slow, especially now that the steroid is lowered and almost tapered off. Is this something that I can do? If so, can I do 2 units, or 2.25 units? She was hitting blue numbers with 2 units. And now, I have a feeding schedule down, so I think restarting will help us to reset and get things managed. I just want to know if there is any downside to doing this and stepping up incrementally until we find the right dose. We have just jumped around so much, I want to make sure that we do this right for Teja.

Thank you so much for your help and advice. Teja and I greatly appreciate it.

 

[Wendy&Neko]

You need to pick a dose and stick with it for a while, so the depot can fill and we can see what that dose can do. Consistency of dosing is needed for us to figure out where to go with a dose. The 2.5 unit dose was not held long enough, but the 3.0 units dose was - if you had been following Tight Regulation for dosing. But not for SLGS.

It would help us help you if you indicated on the spreadsheet, Remarks column, whenever you make changes that can impact blood sugar values, like the changes in steroid amounts.

Please start a new post for a new day - and include the days date on the subject line. That way we can see there is something new. Otherwise your posts can get missed - which we want to avoid.