10/08 Mai AMPS 91, +1 173, +2 127, +4 103, +6 115, +8 208, +9 331, +10 523, PMPS 542

Mai & Dad

Mai & Dad

Member
Hi guys,

Can you please take a look at his ss? I just tested his glucose with ReliOn and got 91. This is basically the number I got at nadir this morning at 3:30am right before I went to bed.

Yesterday this number was 578 (but probably a bounce?). He is o 5.25u Lantus. Should I shoot?

Thank you!
Hao

@Bandit's Mom
 
Bandit's Mom said:
Can you monitor if you shoot? Do you have enough test strips and high carb food?

Have you fed him?
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- Yes, I will monitor him with testing 2 hours apart.
- Got a new box of strips and 20% HC food he likes, got syrup / honey.
- Yes, I have fed him as normal. He just finished eating. Should I shoot 5.25?

Thank you soo soo soooo much for your timely response!!!
 
Yes, please go ahead and give the shot. Don't fill him up. You want him to be hungry enough to eat every hour.

Please test at +1?
 
Just gave him the shot. I will test again at +1.

Thank again for responding to me within such a short time frame. Truly appreciate it!

Should I respond to this thread when I get this new number today (and update the title?)

And one quick question about +1. For example today, I got 91 at 9:35am. He got his insulin at 10:00am sharp. Should I consider +1 at 1035 or 1100? Thanks!
 
Mai & Dad said:
Should I respond to this thread when I get this new number today (and update the title?)
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Yes, this is your thread for the day. Please take off the "Should I shoot?"from the title?


Mai & Dad said:
And one quick question about +1. For example today, I got 91 at 9:35am. He got his insulin at 10:00am sharp. Should I consider +1 at 1035 or 1100? Thanks!
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Test times would be with reference to the time he got insulin. So, +1 would be at 11am.
 
Mai & Dad said:
Thank you for following up on this! I am hoping this is just normal food intake and it's not a bounce :facepalm:.
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Seems like more than a food bump. It's probably the beginning of a bounce. A test later in the cycle (+3 or so) will confirm.

It's good you shot the full dose. Will help limit the bouncing to some extent.
 
Bandit's Mom said:
Seems like more than a food bump. It's probably the beginning of a bounce. A test later in the cycle (+3 or so) will confirm.

It's good you shot the full dose. Will help limit the bouncing to some extent.
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Yeah that's what I am afraid of. Trying to be patient, forget about all the testing / curves with vet for a year, and remind myself we are just starting on LC food and the TR method.
 
Mai & Dad said:
It makes sense and I will try to test him more frequently since we really just got started on TR.
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You are testing enough. In fact, in some cycles you can take a break from tests (when he is clearly bouncing or has stopped dropping/started heading up and get some rest. This is a marathon, so you need to take care of yourself as well! :-)

Mai & Dad said:
- He eats his two main meal right before the insulin shot at 930am and 930pm (CT). He typically eats for 10-15 minutes and I will give him his shot right way (945 ~ 950 ish). I was feeding him 1 can of Tiki Silver Chicken (0.487% carb DMB and 0.9 phosphorous) and 1 can of Tiki Cat Luau (0-4.7% carb depending on flavor and 1.0 - 1.1 phosphorous).
- In the last 5 days, I reduced his main meal from 2 cans to 1 can of Tiki Silver and ~0.6 can of Tiki Cat Luau.
- He gets one Inaba Churu (hairball control version) mixed with prebiotics and psyllium husk morning at night around +2 or +3.
- He gets to scrap the plate of my other cats around +4, which typically leave him a couple of small bites.
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You want to break up his food into multiple small meals. We use food to flatten the curve - so in active cycles like last night and the night before, when is dropping, you want to feed a little food after each test. In fact, considering the drop you saw at PM+2 on 10/6, you could feed a snack at +1 to reduce the diving at onset. It's possible he might have an earlier onset (+1 itself).

Mai & Dad said:
Many say skipping one won't hurt typically, and many think that need to be avoided at all cost? Do you have a take on this?
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It's again ECID (Every Cat is Different) like a lot of things in feline diabetes. Depends on how the cat's numbers have been been, the propensity or history of ketones etc. I don't see a reason to skip unless you are dealing with an overfull depot and a skip can help drain it. Even a token dose is better than skipping altogether.


Mai & Dad said:
- Left ear pic and right ear pic. Thanks for checking on the graph!
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The bruising I am seeing is when you hit the marginal vein and that is normal. Are you seeing bruising otherwise?


Mai & Dad said:
And I know I sound like broken record as this point but thank you for your timely and detailed response. While I have been lurking and posting on this forum, this is really the start of us following TR method tightly with proper home testing. So thank you for making this new start easier for us!
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:bighug::bighug::bighug:
The food change and TR will make a difference to his numbers. :-)
 
Bandit's Mom said:
You are testing enough. In fact, in some cycles you can take a break from tests (when he is clearly bouncing or has stopped dropping/started heading up and get some rest. This is a marathon, so you need to take care of yourself as well! :)


You want to break up his food into multiple small meals. We use food to flatten the curve - so in active cycles like last night and the night before, when is dropping, you want to feed a little food after each test. In fact, considering the drop you saw at PM+2 on 10/6, you could feed a snack at +1 to reduce the diving at onset. It's possible he might have an earlier onset (+1 itself).


It's again ECID (Every Cat is Different) like a lot of things in feline diabetes. Depends on how the cat's numbers have been been, the propensity or history of ketones etc. I don't see a reason to skip unless you are dealing with an overfull depot and a skip can help drain it. Even a token dose is better than skipping altogether.



The bruising I am seeing is when you hit the marginal vein and that is normal. Are you seeing bruising otherwise?



:bighug::bighug::bighug:
The food change and TR will make a difference to his numbers. :)
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Thanks again. And I am so glad you brought up the diet issue. He was free fed his entire life and it took him quite a while to get used only getting two meals per day. I even had to argue with my vet on feeding him two churus per day. And even now he throws up occasionally after +9/+10, which I believe are mostly due to him not getting anything after +2.

Do you think I should try to break it up now or wait for him to stabilize a bit?

Btw, do you think he didn't have a bounce in the morning and or it was flattened by insulin? He is getting another spike (208) now at +8. Hopefully his PMPS won't be too bad.
 
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Definitely feed him more than two times a day! Even human diabetics are told to feed multiple smaller meals. The "two meals a day" is old school thinking from the older insulins that hit hard and fast. Lantus is a much gentler insulin. We do have a number of people here whose cats are grazers, which is OK too. Just try to pull food up a couple hours before the next shot time so his preshot number is not influenced by recent food. This last point is something we tell new people, until they have more data on how their cat responds to food.
 
Wendy&Neko said:
Definitely feed him more than two times a day! Even human diabetics are told to feed multiple smaller meals. The "two meals a day" is old school thinking from the older insulins that hit hard and fast. Lantus is a much gentler insulin. We do have a number of people here whose cats are grazers, which is OK too. Just try to pull food up a couple hours before the next shot time so his preshot number is not influenced by recent food. This last point is something we tell new people, until they have more data on how their cat responds to food.
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Got it. So I will be breaking his main meal apart? Right? Should I start tomorrow?

Or should I wait for his curve to get a bit more regulated? He was pretty stable today until an hour ago at +8 I got 202, and now I got 331 so maybe he is still adjusting his insulin dosage? Though it has been like 5-6 days.

And if I do start feeding him smaller meals, what happens when I have to be out all day? Use an automatic device?
 
You can start breaking up the meals anytime. In fact, doing so may help get him regulated more quickly. Just try to feed most of his food in the first half of the cycle before he nadirs, as after that the insulin starts to wear off and carbs then can make it wear off faster.

A lot of us use autofeeders. The Petsafe 5 is the model I used, but there are others such as the Catmate. Ideally get one that rotates so can rotate to an empty slot a couple hours before next preshot. And one with a spot below to put a gel pack or ice cubes will keep the food cooler and fresher, especially in the summer. If you are alway all day, you'd try to make sure the autofeeder rotates to fresh food around the time he has his lowest numbers.
 
Wendy&Neko said:
You can start breaking up the meals anytime. In fact, doing so may help get him regulated more quickly. Just try to feed most of his food in the first half of the cycle before he nadirs, as after that the insulin starts to wear off and carbs then can make it wear off faster.

A lot of us use autofeeders. The Petsafe 5 is the model I used, but there are others such as the Catmate. Ideally get one that rotates so can rotate to an empty slot a couple hours before next preshot. And one with a spot below to put a gel pack or ice cubes will keep the food cooler and fresher, especially in the summer. If you are alway all day, you'd try to make sure the autofeeder rotates to fresh food around the time he has his lowest numbers.
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Thank you. I guess I will get that started tonight. He had 578 AMPS yesterday morning. I thought we are making progress but it's only +10 right now and he is already 523. Guess we are not really making any progress.
 
Mai & Dad said:
Guess we are not really making any progress.
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I beg to differ. Between mid last night and this morning, he had a stretch of at least 6 hours in normal numbers. That's fantastic progress! Yes, bounces happen, but eventually he'll see enough of those normal numbers that he'll stop bouncing so high. The other progress I'm seeing is that he's not bouncing very long. For many cat they have six cycles of bounces before coming down into normal numbers again.
 
Wendy&Neko said:
I beg to differ. Between mid last night and this morning, he had a stretch of at least 6 hours in normal numbers. That's fantastic progress! Yes, bounces happen, but eventually he'll see enough of those normal numbers that he'll stop bouncing so high. The other progress I'm seeing is that he's not bouncing very long. For many cat they have six cycles of bounces before coming down into normal numbers again.
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Thank you for the comforting word! I need to keep reminding myself to be patient. It's just the thought it has been a year and I still haven't been able to get him well regulated... and that guilt sometimes make me lose my cool.

And I was expecting his Glucose to be in 700~900 by PMPS based on how fast it was rising...
 
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You are testing enough. In fact, in some cycles you can take a break from tests (when he is clearly bouncing or has stopped dropping/started heading up and get some rest. This is a marathon, so you need to take care of yourself as well! :)
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@Bandit's Mom sorry one quick question. You mentioned when he is clearly bouncing I can take a break from tests. Is that essentially what I saw today (10/07) in the afternoon? He went from 208 +8, to 331 +9, and then 523 +10?

Is it irrational to fear that he may go all the way into the 600+? This is why I continued to test into the night. He was at 542 at PMPS and then I have testing him from then to now (+4) and I am sitting here waiting to get his +6.

At what point (when you look at peak glucose) do I bring him to the vet? And how do we typically cope with unhealthy and obsessive testing? I feel like with him showing signs of nausea at high bounces and etc., I have spent the last a few days entirely on him. And I just sat there in between testing sort of rigid and worried. A bit embarrassing to admit that but I thought I'd rather learn a few tricks from you guys...

Thanks again!
 
Mai & Dad said:
You mentioned when he is clearly bouncing I can take a break from tests. Is that essentially what I saw today (10/07) in the afternoon? He went from 208 +8, to 331 +9, and then 523 +10?
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Yes, if you see...he was higher than the AMPS throughout the cycle and really zoomed up at +8. It was okay to stop testing then till PMPS.

Mai & Dad said:
Is it irrational to fear that he may go all the way into the 600+? This is why I continued to test into the night. He was at 542 at PMPS and then I have testing him from then to now (+4) and I am sitting here waiting to get his +6.
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The reason we test is to (a) keep the kitty safe from low numbers and (b) to collect data on onset, nadir etc - basically how our kitty is responding to insulin so that we can use that for dosing decisions as well as shooting low etc. Beyond a point, you cannot control how high he will bounce - all you can do is get him to a good dose and feed the curve. As he gets used to lower numbers the boncing will reduce - he will not bounce as high and he will clear bounces faster. Till then, bounce cycles are a good time to catch up on sleep and get some "me time"! :-)

You can call it a night tonight. He seems to be bouncing and is pretty high and flat. Looks like a repeat of the AM cycle of 10/7.
 
Bandit's Mom said:
Yes, if you see...he was higher than the AMPS throughout the cycle and really zoomed up at +8. It was okay to stop testing then till PMPS.


The reason we test is to (a) keep the kitty safe from low numbers and (b) to collect data on onset, nadir etc - basically how our kitty is responding to insulin so that we can use that for dosing decisions as well as shooting low etc. Beyond a point, you cannot control how high he will bounce - all you can do is get him to a good dose and feed the curve. As he gets used to lower numbers the boncing will reduce - he will not bounce as high and he will clear bounces faster. Till then, bounce cycles are a good time to catch up on sleep and get some "me time"! :)

You can call it a night tonight. He seems to be bouncing and is pretty high and flat. Looks like a repeat of the AM cycle of 10/7.
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That is solid advice. I actually did stay up to get his nadir and then tested him again at +7.5 (~5am CT) since he threw up at that time. Now I am accumulating more data, hopefully next time I can feel comfortable taking a day off (hopefully it won't happen very often xD)
 
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