1/31: Pablo's AMPS 428, +6 371, Advice needed

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Holly and Pablo

Holly and Pablo

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(No condo for a couple weeks.)

WCR: The chin issue that I was so worried about a few weeks ago cleared up with just antibiotics (no steroids, like my vet suggested). His incisions from the upper canine extractions look great and he's adjusted well without the teeth.

Now on to the frustrating stuff. Pablo has been on Lantus for almost three months, and we're really not getting anywhere. I increased from 3.75u to 4u about a week ago and only saw blue twice. That's been the story the whole time. A sea of pinks and yellows with very few blues and greens. Actually, I'm pretty sure I saw more blue on less than 3 units than now! He did probably have some very low numbers during the day this past Thursday because his PMPS was only 165 (and I forgot to leave food out during the day :shock:).

Can you guys take a look at my SS for the last few weeks and give me some thoughts?

Here are my thoughts:
1. I think I'm holding the dose for too long. I end up keeping it for weeks trying to figure out if I'm dealing with NDW (which seems to always happen) or rebound issues (which also seem to happen too).
2. If he has a blue or a green, and then pinks for 4-5 days, is that still rebound? Shouldn't it only take a couple days to clear? At what point to you stop calling it rebound and instead call the good numbers a fluke? What I mean to say is, maybe it's not good numbers followed by days of bad ones. Maybe it's bad numbers with an accidental good one every one in a while. Does that make sense?

Help! confused_cat
 
Hi Holly

nice to see u back.
Glad to hear no steroids were used!
Is Pablo on any meds still? Any other health issues that may be a concern? Any ketones tests lately?


Hoping you can get some feedback soon for Pablo from the experienced ones.

Have a good day :razz:
 
Hi Holly,

I have vague recolletions of you guys.
Prior to Heather suggestng you increase had you received guidance off the board for Lantus use?
I'm seeing a general pattern of flat cycles with an occasional dip into blue/green.-Flat cycle would suggest not enough insulin.

This isn't my area at all, but has anyone mentioned acromegaly to you?
I'm going to pm Nina as she 's the main person in this isg that springs to mind to have a lok at your ss.

Alternatively it could be that you haven't found your breakthrough dose (ours was 4 or 4.25u)it's the flat cycles that make me say this second.

Does Pablo have a clear 2 hours without food before his amps and pmps? I get the impression he may be a free feeder?
 
Hi Holly!

To me it looks like Pablo just hasn't reached his dose yet. There is some blue scattered about, but nothing consistent enough to say that he can't handle more insulin.

I would try following the protocol for increases more closely. The longer he stays in higher numbers, the more glucose toxicity will build up and the more insulin it will take to break through that toxicity. It is possible that once Pablo DOES get to a good dose and break through the toxicity, that his dose will go down quickly, but we have to get the breakthrough first.

He has had some blue on this dose, so our guidelines recommend holding the dose for 10 cycles. He has been on the dose for 17 cycles so you can increase to 4.25 tonight. Depending on the numbers, I would go ahead and increase again after 6-10 cycles. Get as many spot checks as you can to see what is going on. If it's obviously rebound, then yes you can stall a cycle or two on an increase, but you're right, if it's been more than a few days then it's probably not just rebound and it would be ok to increase. You can always post and we'll help you figure it out, you don't have to do it by yourself unless you want to!
 
I don't mean to be a stranger! I wish I could be here more often, but I'm in school/at work for 10-12 hours a day, five days a week. That means I won't be getting very many AM cycle spot checks. I'm trying to bribe my sister who is living with me to test him, but she is grossed out by it. I even told her I would pay her $2 each time. I mean, I thought that was an awesome deal. After all, I change her daughter's diapers for free. :roll:

To answer questions:
1. No, Pablo isn't on any meds except Liqui-Tinic, the vitamin supplement, for anemia
2. The last ketones test was a month ago with his urinalysis and chemisty bw, but I will try to catch him in the litter box tonight
3. Health issues? He has started drinking more water again. After I started Lantus, his consumption went down considerably, but it's back up the last couple of weeks.
4. He only wishes he were a free-feeder! :lol: He gets food at each shot and a 1.5-3 ounce snack at each +6 in a timed feeder. He doesn't have any food closer than five hours to his shot.
5. Prior to Lantus, I used Vetsulin and PZI with little input from my vet (my boss), so I started the Lantus without his input too. Everything I know about Lantus and its use I learned from this board. I read all the documents, and then just jumped right in. I got a lot of things wrong (like not testing every day or before shots, increasing by whole units, not giving shots at the same time, etc.), but when I started posting more regularly, I was set straight! You can actually see that date based on my SS because I went from testing once or twice a day to testing every hour on 12/6. Hahaha.
6. I thought acro cats wouldn't respond at all to small doses like 2 or 3 units, and we have seen some blues. Is that not a correct understanding? I don't know much about it.

So I increased to 4.25 tonight. I have been leery of increases mostly because I can't be here to check him. Until I can sucker my sister into testing him, I can't get spot checks except at night, so I'm nervous about what happens during the day.

Libby...let me make sure I understand this correctly. If you see blue in the middle of the 10 cycles, do you increase after 10 cycles from the START of the dose? Or do you wait 10 cycles from the blue numbers? Thanks again for the help!
 
So I increased to 4.25 tonight. I have been leery of increases mostly because I can't be here to check him. Until I can sucker my sister into testing him, I can't get spot checks except at night, so I'm nervous about what happens during the day.
Click to expand...

hmm, well, is it possible to get an out the door test every morning and make that a habit?
The thing is Holly, sooner or later, Pablo is gonna wake up to a nice number where u will have to decide what to do to keep him safe.

So that means you may have to stall in the mornings...start thinking about this now so u don't get caught off guard...u want to avoid skipping shots, as it will empty out the shed right?

so if u can somehow grab at least one out the door check, that gives u an extra number for the day cycle.
There's still the weekends and the days off, that's when u dedicate the day for a curve if u can. To fill in the blanks for the day cycle.

Maybe u will have to increase that $2 wage to $5, it could very well be worth it in the long run.

Another idea is to push your 12/12 schedule earlier.
 
Holly and Pablo said:
Libby...let me make sure I understand this correctly. If you see blue in the middle of the 10 cycles, do you increase after 10 cycles from the START of the dose? Or do you wait 10 cycles from the blue numbers? Thanks again for the help!
Click to expand...

From the start of the dose, but it's not that cut and dried really. 10 cycles is the MINIMUM to hold the dose at that point, but when there's blue showing up on the spreadsheet that is our cue to slow down and really let the dose settle before changing it.
 
The problem is that I can't alter my schedule for insulin at all (even by 15 minutes in most cases) because I literally have to walk out the door at 5:45am on M, Th, and F and can't be back home until 5:45pm when I get off work. I already have to ask my mother to give him insulin on Thursdays when I'm gone 5:45am to 7:45pm, and I can't ask her to do it every day of the week. So my AMPS is my out-the-door three days a week.

I can get at an AM+2 Tuesdays and Wednesdays, so I'll make that a habit.

Ahhhh....stalling in the mornings. What a frightening thought. If I do get a really low AMPS number, I can get my mother to give the insulin up to 1.5 hours late before she goes to work. She's fine with testing and the shots. I haven't really had to worry about stalling because he's never anywhere close to dangerous!
 
Somebody upstairs must have heard my complaints because I just got a call that my clinical tomorrow morning is canceled! A little snow yesterday and the school district where my hospital is located CANCELED CLASSES! WOO-HOO! That means I can do a curve tomorrow morning with the new 4.25 dose!

Oh, and it also means that I don't have to leave my house at 5:45 in the freezing morning! party_cat
 
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