10/29/14 Oz took 4 readings in a row this AM

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Ian & Oz

Ian & Oz

Member Since 2014
Hello,
After a night of better numbers & keeping an eye on him, this morning was confusing.
I tested Oz at 9:00 am, he was at 305, knowing that if you don't get enough blood you can get false readings I tested again, he was at 281 at 9:04 am then 261 at 9:07 & finally 245 at 9:10. Within 10 minutes his levels spanned 60 points, 24 points between 305 & 281, 20 points between 281 & 261 & 16 points between 261 & 245. I know that there's a +/- 20% margin on these meters, but I'm also wondering if he was actually dropping that quickly in ten minutes? The reason I'm wondering is, based on the higher number (245) I didn't test him until +4 & found that he was at 80, I retested thinking about earlier this morning & he was at 72 about a minute or two later. Getting multiple readings in a row really adds more to the confusion, trying to figure out what his level might actually be.

Ian
 
that is super confusing!

my thought is that all of those readings were probably accurate - he likely was bouncing from the blue numbers last night. And perhaps the bounce was very brief and beginning to resolve already by the time you got to testing him this morning. That's not uncommon for a cat that's gotten used to good BG numbers. They often will stop bouncing, but before they stop, they can have either mini-bounces, like going up to 180 or 200, and then coming back into normal numbers fairly quickly. They also can bounce high but resolve more quickly than they did earlier.

In any case, he's resolved the bounce and settled nicely into green - i'd get another test in 1/2 hr or so. you want to know how low he goes in this cycle and if he goes below 50, catch him with carbs to bring him up and then reduce his dose tonight.
 
Hi Julie,
After I saw the 72 i gave him 2 or 3 tsp worth of food, I'm going to re test him now.
If he's below 50 you reduce the dose?
What if he happens to go below 50 & you don't catch it & give the regular dose?
Good to hear from you!
Ian
 
Newly diagnosed cats (within the first year is considered newly diagnosed) have the best chance of their pancreas healing and going off of insulin. When you're starting out, we encourage people to go by the protocol guidelines. That includes reducing the dose if your cat goes below 50. After doing that a few times, if we learn that a cat doesn't "hold" the reduction, meaning that they have to go back up in dose in order to keep having green numbers, then we talk about plan B.

At this point, you're on Plan A, following the protocol as it's written, which means you want to reduce the dose by 0.25u if Oz goes below 50. Him going below 50 tells you that the dose has become too big and that he needs less insulin.

I think you're asking about if he goes below 50 and you're not home, or you don't catch it on a test, so you can't be sure that he did go below 50? Is that the question? We go by the tests - so if you don't get a test below 50, we would say to stay with the present dose until you do catch one below 50. That's usually not a problem. Reducing in advance because you *think* a cat might have gone below 50 isn't recommended. Was that what you mean?
 
just saw his 73 pop up on the ss - so he's surfing, not dropping. We'd posted at the same time earlier and I missed your last post.

I think you can relax and get another test later in the cycle. you're doing great with the feeding - whatever it is you're doing is working.

Looking great, Ian!
 
Yes, I was concerned if he dropped below 50 & wasn't tested during that time ( it wasn't caught) if it would be bad giving the regular dose. Since I didn't test until +4, I'm hoping i didn't miss any lower numbers.

Ian
 
I wanted to give you Davidson's Spreadsheet to look at. He made a switch to normal numbers at 2.75u. Look at February 1st and you can see the change in the colors of his spreadsheet compared to pre-February.

Then notice Feb 9th, when Shawna shot her first green number. Look across that row and see what happens when she shot the green number with the full dose. He only moved about 30 points in the whole daytime cycle, then that evening he had a last-gasp reaction to being in normal numbers with a mini-bounce up to 136, followed by returning to normal numbers.

From that point on, Shawna reduced his dose either
1. if he went below 50 or
2. if he spent 7 days in normal numbers (under 120) at one dose.

from the TR Protocol guidelines:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s.

Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
Click to expand...

Cats go off of insulin (OTJ = off the juice) in different ways. I'm telling you all of this because Oz's ss looks promising. I can't say for sure, of course, but he's taking the first steps in that process. You've raised the dose to the point where he's having nadirs under 100 now. His bounce time has reduced to just a few hours. The goal with Tight Regulation is to get a cat in the 50-120 range and hold them there so their pancreas can heal, and hopefully sputter back to life and begin producing insulin again. The goal isn't to reduce the dose as soon as possible, but to keep the dose high enough that he stays in normal numbers for as long as possible.

Does all that make sense?
 
That makes sense, it takes awhile for all of this new information to sink in, so many variables to understand.
Thank you so much for all of this help & information!!

Ian
 
believe me, i understand. the action of insulin in a cat's body is almost odd, especially the whole bouncing thing. It takes a while to understand it because so much of it is counterintuitive. And then there's shooting low - who would think that shooting a 300 and causing a 200 point drop wouldn't kill a cat when you shoot the same dose into a 100? It goes against logic, which is why so many people have a hard time doing it.

That's why so many of us stick around to help teach new people. There are quite a few of us, and others taught us. That's really the only way to learn. Most vets don't have that much experience with diabetic cats. In my 3 vet practice, punkin was one of 2 diabetic cats ever. My vet hadn't even heard of acromegaly. He was a great vet - I'd been with him for probably 20 years and a dozen pets, but I had to switch with punkin. Even then, my new vet had 2 diabetic cats but she didn't know much about Tight Reg - she just shot blindly and treated hypos with karo.

I like the control of hometesting and following the TR dosing a lot better.
 
My vet is the same, he knows a decent amount about it but seems to have a generalized plan.
He said to start at one dose of 3 u, when that wasn't working I asked about twice a day & he said go to 2 u, twice a day, which may have been too much to start with from what I've learned here, I think the rule here is start at 1u. He said most people test once a week. Oz has had a very good day so far, from +4 to +7 his numbers were 72,73,71 & 72. Wondering if tonights pre shot is going to bring about more questions about his dose. If he's 150 or above, given todays numbers is it ok to give the full 2.25u dose?

Ian
 
There is no rule about a starting dose - there is a weight-based formula on the Tight Reg Protocol page. There are some people on here who suggest everyone start at 0.5u or 1.0u, but the weight-based formula is suggested for all the cats. If they were on another insulin before switching to Lantus/Lev, then we look at what dose they were on and what it did to their BGs before suggesting a starting dose.

I think if you're able to monitor, you've gotten quite a bit of data on how Oz is responding to insulin. It's up to you - as long as he isn't lower at pmps than his lowest point today, the nadir in the 70's, you're probably ok shooting it.

But . . . saying that, our "rule" is that if we encourage someone to shoot low, we need to be available to monitor the cat with them, just in case there are low numbers. I'm not going to be available tonight.

I'd suggest that you post and ask for help if you're uncertain about what you'd like to do.

Did you get a chance to read that post on shooting low that i linked last night for you? Please read through that and look at the links that are included in it, like the one to the "Becoming Data Ready" in the "Shooting and Handling Low Numbers" yellow starred sticky in this forum. That'll help you be prepared for shooting low. And yes, when you shoot low, you are shooting the full dose that you've worked up to safely and methodically, into normal numbers (50-120). Then you always get a +1 and a +2 whenever you shoot a lower-than-you've-shot-before number so you can see what's coming.
 
Ok,
I've pulled up the Becoming data ready & will read it.
Thank you again for all of your help!

Ian
 
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