1/6 - Gen, AMPS >400, +1 >400 - stubborn highs/dosing questions

[Allie & Gen]

Yesterday

Good morning! I hope everyone has a very pleasant Tuesday, with safe surfs for the kitties.

I'm still hoping that one of our experienced veteran users can share some thoughts on Gen's lack of progress, specifically in relation to this pattern: lots of high numbers almost all the time, and when he starts to get lower numbers, a sudden plunge that earns a reduction - leading to the lower numbers disappearing. Anytime he gets into the blues or greens, he either bounces sky-high, or dives below 70 (our slightly modified SLGS threshold for reductions, intended to take the Libre's exaggerated lows into account).

Basically, it's really starting to feel as though following protocol and taking a reduction immediately whenever he takes a dive ... is a mistake. And I really do not like how high he is almost all the time. (His periodontal disease is very likely a factor ... but even so.) @Christie & Maverick , @Wendy&Neko , @Sienne and Gabby (GA) , you've been here a long time and watched a lot of cats use these dosing methods. I would be really grateful for your thoughts, please. There's a little more context/discussion in yesterday's condo as well. It was suggested that it might make sense, for example, not to take a reduction the first time a dose drops Gen all the way down past 70, but to hold it and only take a reduction after two or three such dives.

(Re: TR and dry food, I am hoping to have Gen on an all-wet low-carb diet by the end of next week, at which point I may consider switching methods, but I'm not sure if it's the right move.)

Thank you all (from veterans to fellow newbies) for your support and care!

 

[Allie & Gen]

Ugh. On top of everything else, I'm wondering if we had a furshot this morning. I didn't think so, but it's +3.5 and he's staying firmly in the "HI" (above 400) zone. I hate this.

 

[Allie & Gen]

Fretting about my boy, and work is not providing sufficient distraction. I want to go home and cuddle him. Since I can't, here are a couple photos of him being cute and relaxed the other day.

 

[JoM]

I can totally relate to all of this. For a while I was following a protocol that said I could go 3 times (days) between 40-50, one under 40. So basically ignore two of them between 40-50 and keep the same dose, but if it drops a 3rd time or goes under 40 to take the reduction. It seemed to work for a while, until Nov 18. Then everything started going wonky. I ignorned that first hypo in the 40's and it plumeted then rocketed up. Because of all the hypos and several under 40, Ive had to keep lowering the dose. Im sure others will weigh in, but that 3 under 50 and one under 40 seemed to work for a while. Hang in there. Im still trying to make sense of it all.

 

[Allie & Gen]

I can totally relate to all of this. For a while I was following a protocol that said I could go 3 times (days) between 40-50, one under 40. So basically ignore two of them between 40-50 and keep the same dose, but if it drops a 3rd time or goes under 40 to take the reduction. It seemed to work for a while, until Nov 18. Then everything started going wonky. I ignorned that first hypo in the 40's and it plumeted then rocketed up. Because of all the hypos and several under 40, Ive had to keep lowering the dose. Im sure others will weigh in, but that 3 under 50 and one under 40 seemed to work for a while. Hang in there. Im still trying to make sense of it all.

Thanks, Jo. I really appreciate the solidarity. It's a lot to wade through.

I think you were following TR, maybe? (Not sure, I haven't got the protocol memorized, but those numbers are much lower than the ones SLGS mandates.) That said, I'm probably going to start doing something like it, with somewhat higher numbers. (Gen's BG was apparently 44 when he was at the ER having a symptomatic hypo crisis; the idea of letting him get under 40 terrifies me. It was an animal meter and I don't really know how to convert, but the number is burned into my brain!)

 

[Staci & Ivy]

Fretting about my boy, and work is not providing sufficient distraction. I want to go home and cuddle him. Since I can't, here are a couple photos of him being cute and relaxed the other day.

View attachment 76336 View attachment 76337

Oh my he’s so handsome Allie
I love his stripes

He’s so cuddly
Purrrhaps the reduced dose a few days ago is contributing to the higher BG. I would think once the depot rebuilds it should help.

Hopefully transitioning to all wet food could help too.
I know you are trying everything to get his numbers down.
You’ll get there. Hang in and give him extra smooches

 

[Wendy&Neko]

44 on an animal meter is way too low. For reference sake, even though the numbers are not proven to be equivalent, folks using a pet meter and following TR reduce when it goes below 68, vs. 50 for folks using a human BG meter. There is no way to convert from animal to pet meter. Many have tried and failed testing the same blood drop with two meters.

Regarding yesterday's discussion, folks who suggested mixing and matching TR with SLGS should read post #37 in this thread: Protocols: Myths Debunked. There is no "wait for more drops before reducing" with SLGS. There is a reason it says "reduce immediately". There are no short cuts with SLGS. Just some modifications you can do once you've been doing this a while, know how Gen uses the insulin and food extremely well. Reducing the reduction point made sense because the Libre is often higher than a BG meter.

I can understand how his numbers would be very frustrating. In the early days, Neko teased me with some blues or even a hint of green (got over 3.5 units first), then went back to her comfort zone of reds and pinks for ages. . With Neko, it was insulin resistance causing by IAA and acromegaly that made it extremely hard for her to maintain low blues or greens. I was following TR, and it still took ages to get to a better dose where she would repeat a green on the same dose. Infection/inflammation from needing a dental also causes a type of insulin resistance. Gen's SS looks like several I've seen of cats needing a dental. Getting that dental should help.

So what to do about it in the meantime? Gen's depot is full, unless you did do a fur shot. When you can, I'd sniff the injection site and see if you smell insulin. SLGS says to wait 7 days, then you can increase again. I agree you did the right thing to reduce, as he seemed to be lingering in greens on the 2nd. Not like the one on the 1st where he may just have laid on the sensor. 301 at +3 to 75 at +4.5 doesn't seem quite right. Especially when you look at the patterns of numbers when he's gone green before.

Keep working at getting him to enjoy more wet food. Following TR will also help.

Lantus teaches us patience.

 

[Briana + Binx]

I had just started writing when I saw Wendy’s post come up and now all I can say is, ^ exactly that. Especially patience, oh boy!!

Hopefully the switch to fully wet will help, it definitely did for Binx. And also switching to TR helped too. So if you feel comfortable and have capacity, it might be worth a try.

Safe surfing

 

[JoM]

Thanks, Jo. I really appreciate the solidarity. It's a lot to wade through.

I think you were following TR, maybe? (Not sure, I haven't got the protocol memorized, but those numbers are much lower than the ones SLGS mandates.) That said, I'm probably going to start doing something like it, with somewhat higher numbers. (Gen's BG was apparently 44 when he was at the ER having a symptomatic hypo crisis; the idea of letting him get under 40 terrifies me. It was an animal meter and I don't really know how to convert, but the number is burned into my brain!)

Yeah, it's confusing because I was doing the TR protocol, then she got pancreatitis, wouldn't eat and the only thing I could get her to eat was dry so I switched to Young Again. I put SLGS as the protocol I use but a custom form of it.I still really use some of the TR protocol. Karamelle has dropped under 40 a lot. I think 25 was the lowest. But she never has any hypo symptoms.

 

[Allie & Gen]

Wendy, thank you so much for your detailed response! I really needed some help straightening my head out on this.

44 on an animal meter is way too low. For reference sake, even though the numbers are not proven to be equivalent, folks using a pet meter and following TR reduce when it goes below 68, vs. 50 for folks using a human BG meter. There is no way to convert from animal to pet meter. Many have tried and failed testing the same blood drop with two meters.

Thank you, that's really good to know - I'll be less freaked out when my Libre creeps down towards 50, knowing that even if it's accurate, it's not actually so close to the numbers he was at that awful morning when his legs stopped working.

Regarding yesterday's discussion, folks who suggested mixing and matching TR with SLGS should read post #37 in this thread: Protocols: Myths Debunked. There is no "wait for more drops before reducing" with SLGS. There is a reason it says "reduce immediately". There are no short cuts with SLGS. Just some modifications you can do once you've been doing this a while, know how Gen uses the insulin and food extremely well. Reducing the reduction point made sense because the Libre is often higher than a BG meter.

Thank you - I've read some of that thread, but it was interesting to follow the link in post #37 and read a bit of the discussion involved in putting the modified SLGS method together. (I'm still not entirely sure I understand why it's so strict about immediately taking the reduction when the kitty drops below 90, which seems like such a high number for a lower limit - I mean, I get that it's about safety and avoiding hypoglycemia generally, but why that number? Maybe it's cited somewhere; I'm too tired to read through and process the whole thread tonight.)

I don't necessarily have to understand these details, obviously, but I feel much better when I do have a better grasp of the mechanism behind something like this. If you happen to have a reference you could point me at, I'd be thrilled.

I can understand how his numbers would be very frustrating. In the early days, Neko teased me with some blues or even a hint of green (got over 3.5 units first), then went back to her comfort zone of reds and pinks for ages. . With Neko, it was insulin resistance causing by IAA and acromegaly that made it extremely hard for her to maintain low blues or greens. I was following TR, and it still took ages to get to a better dose where she would repeat a green on the same dose. Infection/inflammation from needing a dental also causes a type of insulin resistance. Gen's SS looks like several I've seen of cats needing a dental. Getting that dental should help.

Thank you; it's reassuring just to know that you've seen something like what he's experiencing before! As I get to know some of the other cats on this forum, I'm picking up bits and pieces of what has or hasn't been working with them, or the various health conditions that affect them, but trying to compare Gen with most of the others hasn't given me much insight.

So what to do about it in the meantime? Gen's depot is full, unless you did do a fur shot. When you can, I'd sniff the injection site and see if you smell insulin. SLGS says to wait 7 days, then you can increase again. I agree you did the right thing to reduce, as he seemed to be lingering in greens on the 2nd. Not like the one on the 1st where he may just have laid on the sensor. 301 at +3 to 75 at +4.5 doesn't seem quite right. Especially when you look at the patterns of numbers when he's gone green before.

I don't think it was a fur shot ... I tend to test for dampness after each, and there was no lingering insulin smell on him when I got home. (I find the smell test unhelpful right after shooting - I can always, always smell insulin as soon as I've pulled a dose, and can't really distinguish between that and insulin going where it shouldn't.) What an awful cycle, though. I guess his nadirs overall on this dose are pretty similar to the last time he was on 1u, looking at my sheet where I'm just tracking nadirs.

Speaking of that, though ... I'm still a little worried. At 1u, he's never had a nadir below 200. At both 1.25u and 1.5u, he hit reduction numbers in under a week. What do I do if he keeps ... ping-ponging between doses like that? 1u --> increase --> 1.25u --> decrease --> 1u --> increase, lather, rinse, repeat? (That was really the crux of my concern with these posts.)

Keep working at getting him to enjoy more wet food. Following TR will also help.

Lantus teaches us patience.

Hah, okay! I am ... okay at patience, but it seems I have more to learn. Thank you again! If you have a minute to address the bolded question above, I'd be grateful, but otherwise I feel a bit better about things. It helps to have a wider perspective than one's immediate cohort.

 

[Wendy&Neko]

What do I do if he keeps ... ping-ponging between doses like that? 1u --> increase --> 1.25u --> decrease --> 1u --> increase, lather, rinse, repeat?

Going up and down a few times to see if he'll stop. Then if not, see if you can find that 1.0F dose in between the two and see if it's the sweet spot. If you get him on all wet food and can do TR, there are a few more tricks we can try.

 

[Allie & Gen]

Going up and down a few times to see if he'll stop. Then if not, see if you can find that 1.0F dose in between the two and see if it's the sweet spot. If you get him on all wet food and can do TR, there are a few more tricks we can try.

Oh thank goodness, that is really reassuring. I do think TR is in our future soon (probably a couple of weeks out; I'll be away for a couple of days, the 16th-18th or so, and while I'm hiring a very experienced catsitter who has had diabetic clients before and knows his stuff, I'm not about to start a riskier process with Gen in absentia).

 

[Allie & Gen]

And with that, Gen says it's bedtime. Goodnight, friends!