10/2/20 - Squeaky! AMPS 391, +8 = 273 (Last nite's +6 = 356)

I know it's frustrating Molly was the same when I first started. I still get frustrated but if it wasn't for the people here helping me. I don't know what I would've done. I still have to ask questions just to be sure.
 
With Lantus, mid-cycle tests are very important when trying to decide if the dose is working, as the preshot numbers don't always give an accurate picture alone of how the cycles are playing out. We dose based on how low the dose is taking the kitty, not preshots.

I appreciate you have some notes where you decided not to take any tests, but with TR before you increase, you need to make sure he isn't going lower, particular at night. You bumped up to 1.5u, on pm cycle of September 28th - but missed getting any evening data for the three days prior. He may have needed the increase, but without that mid-cycle data, it is really hard to say.

Understanding of basic concepts is key in this whole process: concepts of onset (length of time the insulin reaches bloodstream and begins to lower blood glucose), nadir (lowest point in the cycle) and duration (how long does the dose continue to lower BG). We do this by gathering data, so we can make better decisions on dosing for our own kitty, and how our kitty responds to insulin and food.

Nadirs in each cycle can and do move around. They aren't always at +6. I have had cycles on Lantus where Maverick started out in the 300s, and would drop to the 70s early on, like around +4. Then bump back up at next preshot to 300s or 400s. Without getting those mid-cycle tests, I would have thought he wasn't doing anything and increased the dose. Actually there have been times too, where he actually earned a reduction, because the number was below 50. So, my suggestion is to try and fill in some of the missing pieces, maybe try testing at different times, not always at +6 in the a.m. cycle, and please do try and get at least one test before bed each evening. Many kitties like to go lower at night, so even if you can catch at +2 or a +3 in the p.m. cycle, that will help you to determine how the insulin is actually working.

Does this make sense?
 
Jan D said:
Do I need to do something different to bring numbers down?
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He needs to safely get to the right insulin dose. Insulin is a hormone - you have to increase until you get to a dose that works for Squeaky. However, you do have to do the testing required of the dosing method in order to get there. We need to know how low the dose is taking the cat to know it's safe to increase. @Christie & Maverick I think I was the one suggesting she go to 1.5 units, the first 4 days on 1.25 units there was enough testing to show 1.25 was not enough insulin.
 
Christie & Maverick said:
With Lantus, mid-cycle tests are very important when trying to decide if the dose is working, as the preshot numbers don't always give an accurate picture alone of how the cycles are playing out. We dose based on how low the dose is taking the kitty, not preshots.

I appreciate you have some notes where you decided not to take any tests, but with TR before you increase, you need to make sure he isn't going lower, particular at night. You bumped up to 1.5u, on pm cycle of September 28th - but missed getting any evening data for the three days prior. He may have needed the increase, but without that mid-cycle data, it is really hard to say.

Understanding of basic concepts is key in this whole process: concepts of onset (length of time the insulin reaches bloodstream and begins to lower blood glucose), nadir (lowest point in the cycle) and duration (how long does the dose continue to lower BG). We do this by gathering data, so we can make better decisions on dosing for our own kitty, and how our kitty responds to insulin and food.

Nadirs in each cycle can and do move around. They aren't always at +6. I have had cycles on Lantus where Maverick started out in the 300s, and would drop to the 70s early on, like around +4. Then bump back up at next preshot to 300s or 400s. Without getting those mid-cycle tests, I would have thought he wasn't doing anything and increased the dose. Actually there have been times too, where he actually earned a reduction, because the number was below 50. So, my suggestion is to try and fill in some of the missing pieces, maybe try testing at different times, not always at +6 in the a.m. cycle, and please do try and get at least one test before bed each evening. Many kitties like to go lower at night, so even if you can catch at +2 or a +3 in the p.m. cycle, that will help you to determine how the insulin is actually working.

Does this make sense?
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Yes, Christie, this is very helpful, and I appreciate the detail. Thank you so much. I'm learning little by little and we are making progress.

We will finally have moved up evening testing time to 9 pm tonight if it goes smoothly. And we're still emotional about all of this. I'm trying to get enough sleep so I can be clear and steady, and monitor Squeaky's emotions too so he doesn't get too discouraged. In the last week, I've elected to avoid PS, then shot, then really fast another BG test right away. Three pricks in a short time. But now we are getting better and better at this so it is going smoother and better.

Christie, Are the daily cycles significantly different from the night cycles in any way? Will knowing one well give us enough information about the other? Or, can I not assume anything other than any cycle can change and I can't really predict anything?

So if I was going to do the best job possible, during the next several days, (trying not to pincushion this little guy who hides hours before he thinks this is coming,) how would you orchestrate this data-gathering expedition exactly? Sorry to be so particular about this, but I can do it better if I understand better.

How about this sequence (knowing that I might not be able to do it perfectly):

Friday night, 9 pm PS. 11 am BG (+2)
Saturday: 8:45 am PS, 11:45 BG (+3); 8:30 PS, 12:30 BG (+4)
Sunday: 8:15 PS, 1:15 BG (+5); 8:00 PS, 2 am BG (+6)
Monday: 8:00 PS, 3 pm BG (+7); 8:00 PS, 4 am BG (+8)
Tuesday: 8:00 PS, 5 pm BG (+9); 8:00 PS, 6 am BG (+10)

Would this be enough data to give us a clear picture now of how things are going with Squeaky? When the lantus kicks in, when the nadir is, and what is the duration? Or how would you structure this differently to get the maximum information in the quickest time? THANK YOU SO MUCH.

Hugs from Jan and Purrs from Squeaky
 
Wendy&Neko said:
He needs to safely get to the right insulin dose. Insulin is a hormone - you have to increase until you get to a dose that works for Squeaky. However, you do have to do the testing required of the dosing method in order to get there. We need to know how low the dose is taking the cat to know it's safe to increase. @Christie & Maverick I think I was the one suggesting she go to 1.5 units, the first 4 days on 1.25 units there was enough testing to show 1.25 was not enough insulin.
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Thank you Wendy, okay we are up for it (mostly) and want to understand. I am giving1.5 units but numbers are still in the 300s. I get that we need a broader sample of numbers. I appreciate all the input and help! Hugs from Jan and purrs from Squeaky
 
So, just chiming in here...prednisolone is a steroid...you're giving your kitty steroids right now and that's known to cause diabetes, and perhaps help keep those numbers elevated.

How long is the course of prednisolone going to last?

Keep testing, and let's see if the perfect dose can be found, but I believe you may be swimming upstream with the steroids on board.

I presume it's for the asthma?
 
Sue and Luci said:
So, just chiming in here...prednisolone is a steroid...you're giving your kitty steroids right now and that's known to cause diabetes, and perhaps help keep those numbers elevated.

How long is the course of prednisolone going to last?

Keep testing, and let's see if the perfect dose can be found, but I believe you may be swimming upstream with the steroids on board.

I presume it's for the asthma?
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Great catch, Sue!!!!! Well it's ongoing and it is for the IBD...... the diarrhea and vomiting. Also the pancreatitis, but I'm not sure what those symptoms are. About the IBD, his stools have been solid for the last 2 weeks (as of today, wow we should celebrate) but he had 2 vomits during the last 2 weeks. Last vomit was a week ago. (Oh wait, he did have a diarrhea two days ago but I gave him a new treat which must have caused it. He reverted right back to solid stools after I stopped that treat.)

Asthma, we're managing it with an inhaler and have done so for about 11 years. He did start having coughing episodes recently, so I increased his inhaler from 125 mcg to 250 mcg and it is helping. The last coughing episode was so mild it didn't even really count.

I haven't had the focus to be able to write to the vet to describe all of this and ask questions. I'm glad you caught this and stimulated my mind.... what are your thoughts, Sue? I can get an email to the vet today. Of course she wants Squeaky off the steroids too. Someone suggested a different medicine for the IBD, but she didn't think that was a better idea. Do you think we might be able to start tapering off the prednisilone?

Thanks so much Sue. Hugs from me and purrs from Squeaky
 
I would recommend reaching out to your vet and asking if there are alternatives. Hopefully your vet is aware of how steroids work and how they can influence higher blood glucose levels...

I have my doubts that as long as Squeaky is on steroids that you'll see better blood glucose numbers...

Let's see if your vet has any recommendations for alternatives. 11 years is a long long time to be on steroids ... it's a double edged sword, it can be helpful but can also be detrimental.
 
No, he has only been using the inhaler for 11 years and had to for his asthma. But the steroids from the inhaler are pretty much limited to just the lungs. They are not systemic.

We started prednisilone last year (or so) in small doses for the IBD and pancreatitis. Sadly, one vet just kept increasing it as the diarrhea got worse. Now I have a different vet, and we are down to a comparatively low level. I will write her this evening.

Yes she understands it.

Thank you!
 
I see you've received some good advice. The best way to see what is going on with Squeaky's numbers it to look at the SS and see what areas don't have any numbers filled in. Then when you are able to try and get some test in those areas. That will give you an idea of what he is doing on the dose and when he starts dropping and when his nadir is. Eventually you'll learn to see patterns and be able to have an idea of what he might do on a dose. One thing I learned with Furball was to give her some loving at test time to make it not just be about getting the test done. That way she would not be so stressed out about it. Eventually she learned to come to me at test time and sit still for me.

I had another cat named Squeaky, but she was a girl. She squeaked when she meowed and that's how she got her name.
 
In the beginning, I preferred getting one mid-cycle somewhere between +2 and +5 in the evenings, and sometimes when I tested also depended on what the previous cycle looked like as well as preshot test. For me, I wanted to see where he was onsetting, since I also built a snack routine around the early part of the cycle. That is also a consideration, depending on when you feed Squeaky, what carbs, and how carb sensitive Squeaky is, your situation will be different. Since I was working downtown then, I would try and get a +1 before I left (again depending on the preshot), because I couldn't get midcycle tests during the day. Carla likes a test around +10.5ish, so she can see if Furball is rising to preshot. We definitely don't all do this exactly the same, and it takes time to get a feel for how your own cat processes insulin.

That said, you definitely don't need to make a pincushion out of Squeaky :p. As Carla @carfurby said, try and fill in missing areas, you don't need to do it every cycle, but spot check now and again where you normally wouldn't test.

I think I was hung up on the increase from 1.25u to 1.5u because as @Wendy&Neko said there were enough tests the first 4 days to show 1.25u wasn't enough, and I don't disagree. From my perspective when I saw those cycles, I had a "yes, probably should increase, but" moment. I wondered what happened earlier on pm cycle of Sept.21st. Was it lower, and he was coming up by your test at +9? Don't know. From then to the 24th, I think I would have been curious about getting something one of those nights before +9, just to be sure he wasn't coming down to better numbers, but then climbing back up by +9. Wendy has seen countless more spreadsheets than me over the years, so she likely didn't have a "yes, but moment" ;)

I too saw the pred, but without having first hand experience in diabetic cats, I wouldn't know for certain how much the dose you are giving could be affecting his BG levels.
 
carfurby said:
I see you've received some good advice. The best way to see what is going on with Squeaky's numbers it to look at the SS and see what areas don't have any numbers filled in. Then when you are able to try and get some test in those areas. That will give you an idea of what he is doing on the dose and when he starts dropping and when his nadir is. Eventually you'll learn to see patterns and be able to have an idea of what he might do on a dose. One thing I learned with Furball was to give her some loving at test time to make it not just be about getting the test done. That way she would not be so stressed out about it. Eventually she learned to come to me at test time and sit still for me.

I had another cat named Squeaky, but she was a girl. She squeaked when she meowed and that's how she got her name.
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Thanks, I do all the loving things, but he's kind of depressed. He hates the pricks and shots. Also he hasn't had any good numbers for a looong time, so he hasn't felt good for a long time, either.
 
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