10/9 Still Dreaming of Greens...Suggestions Needed

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WenDawg

WenDawg

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Would someone be willing to take a look at Abernathy's spreadsheet and give me some feedback? I am finally seeing some blues, but I am still dreaming of greens. I am now giving the same dose for AM and PM. It took me a little while to work up to that. Should I just continue to slowly increase until I see some lower numbers? I am using U100 syringes, so I increase by .4 each time. Should I also set my alarm to wake up in the middle of the night to see what's leading to the very high AMPS? Any thoughts would be welcome :smile:
 
Those are very nice blues. I don't know whether he is bouncing or whether the insulin isn't lasting long enough. (2 different problems with different solutions) A curve especially with numbers in the +8-10 range will tell you whether he is gradually rising or jumping up. A midcycle at night and maybe +9-10 in the early morning will also give you good information.

How is he fed? Sometimes you can flatten that curve out with food. As he is dropping way down from preshot, some food around the time when he starts to drop (more info to be gained from a curve) might give him more of a surf and slow the bouncing.
 
Thanks Sue for taking the time to look at his spreadsheet. I appreciate it.

I feed him about 20 minutes before his AMPS after I've checked his BG. I then usually feed him a snack portion around +6-+7 as he's practically begging for food. At night it's the same routine minus the +6-+7 snack as I'm sleeping. He only gets Fancy Feast classic and a low carb treat from time to time. I'll try to get some more numbers at the time intervals as you suggested to see if that gives better insight.

Would you suggest keeping at the same insulin dosage until getting additional BG readings?

Thanks again.
 
I'd keep the dose the same until you figure out what is going on. Could you divide up the amount he is getting fed into 4 meals per cycle? (automatic feeders work great for this). I'd try giving him a snack at +2 (to slow the drop) and maybe +5 (to keep the nadir up a little or be a little later in the cycle) and then maybe around 8/9 and then after the pmps shot. Would that be doable?

My thinking is that if he is dropping fast after the shot and over 50% lower in that 5-7 range. If he'd flatten out and the nadir would be a little later, maybe the cycle would be longer and the bounce not so high. Worth a try?
 
Still not sure whether that's a bounce or too short a cycle. If too short a cycle, more insulin is needed. If a bounce, more insulin would probably make it worse. I'm betting on a bounce.
 
OK....After a super busy few days and buying an automatic feeder, I fed Abernathy 'snacks' last night and today at +3, +5 and +8. I also was able to do a curve today. And I decided to bump up his dosage by 0.4 starting today. So far, I don't see much difference. He's still running high at both the AMPS & PMPS. Any thoughts? Suggestions?

On a side note, he's looking healthier, has more energy, has put some weight back on (he's still thin, just not as sickly looking) and his coat is shiny.

Thanks in advance!!
 
I'm glad he is looking and feeling better. I like your increase. He is dropping into blues, but safe nadirs. I imagine he will still bounce, but maybe the numbers will be lower overall.
 
WenDawg said:
I feed him about 20 minutes before his AMPS after I've checked his BG.
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I don't know if this will make a difference but you want to make sure that Abernathy does not eat two hours before his pre-shot BG test...which I think you are doing. However, you might want to test, feed and shoot all within about 10 minutes instead of the 20 minutes. He may be going up a little higher than your pre-shot test is showing.
 
Merlin said:
WenDawg said:
I feed him about 20 minutes before his AMPS after I've checked his BG.
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I don't know if this will make a difference but you want to make sure that Abernathy does not eat two hours before his pre-shot BG test...which I think you are doing. However, you might want to test, feed and shoot all within about 10 minutes instead of the 20 minutes. He may be going up a little higher than your pre-shot test is showing.
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Thank you for the advice. I will try that. And he is definitely not eating for about 2-3 hours prior to his pre-shot BG test. His pre-shot numbers are looking a little better, but still not ideal.
 
Pre-shot numbers are still running high...I've been consistent with small snacks throughout the day, I've increased his dosage slightly, but those numbers don't seem to want to budge. I just don't know what to think :?
 
I wonder about giving him a snack around +4 and avoiding giving him food after 6 to see if less food would keep that pmps from jumping up.

He is clearing bouncing for pmps but not nearly as much for amps. Not sure why the difference. It could be that the insulin isn't lasting long enough, but that should show us a similar pattern am and pm. I wonder about increasing the dose by .25 and giving that pm dose 30 minutes early, the am dose 30 minutes later and seeing if it makes the curve a little shallower.

I know I have given you three separate suggestions here. I wouldn't do all three at once.

He really is getting decent numbers in the middle of the cycle; it's just the pmps that is ugly. He will eventually settle in; it is just frustrating to see that black.
 
Sue and Oliver (GA) said:
I wonder about giving him a snack around +4 and avoiding giving him food after 6 to see if less food would keep that pmps from jumping up.

He is clearing bouncing for pmps but not nearly as much for amps. Not sure why the difference. It could be that the insulin isn't lasting long enough, but that should show us a similar pattern am and pm. I wonder about increasing the dose by .25 and giving that pm dose 30 minutes early, the am dose 30 minutes later and seeing if it makes the curve a little shallower.

I know I have given you three separate suggestions here. I wouldn't do all three at once.

He really is getting decent numbers in the middle of the cycle; it's just the pmps that is ugly. He will eventually settle in; it is just frustrating to see that black.
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Thank you for the advice. I am up for trying anything!!! Today I am starting with the first suggestion of food at +4 only. I will try that for a few cycles and then move to the next suggestions.

I am not sure what the difference is between the AMPS & PMPS as everything is the exact same for both. The only difference would be his activity level at night is much lower than during the day.
 
Back with an update...Since 10/30 I only gave a snack at +4. Now his AMPS and PMPS are consistently running in the 500s :sad: So that doesn't seem to be working.

I can only guess that I need to go back to multiple snacks throughout the day. While his numbers weren't great, they were better than they are now. Any thoughts on this?

Which such bouncing, should I ever consider cutting back on the insulin dosage to try and get it under control? This is all such a guessing game :?

Thanks in advance for any advice you can provide.
 
It is a guessing game. Frustrating, huh?

The insulin brings down his numbers, 50% and more, which is great. The numbers in the middle of the cycle are under the renal threshold, which is also great. All along, I have wondered whether he jumps at +11 (unusual reaction) or if the insulin wears out at +11 (more likely).

I think we have talked about dosing a smaller amount 3 times a day and your schedule won't work for that. I wish there was a way to give the shot at +11 before the jump but I can't figure out a way to do that consistently am/pm. The only thing I can think of to do is to increase and see if the increased insulin will last that extra hour. I was thinking increasing could make the bouncing worse but it doesn't seem that those amps/pmps numbers can be much higher.

Wish I had the perfect solution for him. He definitely has an unusual pattern.
 
There is another technique besides TID which might possibly work.
It has been used rarely (and successfully), and is not part of any standard protocol per se.
And trying it means first doing so on days when you can monitor how it works.

That said, is it possible you could divide the dose for both am and pm into a main dose and a tiny booster that was given 1 hour later?
For example, if you normally gave 1 unit, could you split in into 0.75 and 0.25 and dose the tiny piece an hour later than the 0.75 units?
Or, if you normally give 1.5 units, you could divide it into 1 unit, and 0.5 units.
That might improve the duration just a hair and make for smoother numbers.

What do you think about that idea?
 
Thank you both for taking the time to reply. I appreciate it. As an update, last night I started the small snacks again at +3, +5, and +7 and his AMPS number was 376, so that was better (although not great). So, I guess it's clear he needs those small snacks.

I like the suggested dosing technique and think I will give that a try. I'm home a lot this week and can monitor him. I'll start that tomorrow and report back my results after a few cycles.

I love all the suggestions I get from this board as I know that I'd never get them from my vet. It truly is helpful. :-D
 
BJM said:
There is another technique besides TID which might possibly work.
It has been used rarely (and successfully), and is not part of any standard protocol per se.
And trying it means first doing so on days when you can monitor how it works.

That said, is it possible you could divide the dose for both am and pm into a main dose and a tiny booster that was given 1 hour later?
For example, if you normally gave 1 unit, could you split in into 0.75 and 0.25 and dose the tiny piece an hour later than the 0.75 units?
Or, if you normally give 1.5 units, you could divide it into 1 unit, and 0.5 units.
That might improve the duration just a hair and make for smoother numbers.

What do you think about that idea?
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I like this suggestion and will try it starting tomorrow morning. Abernathy gets 3.2U at each dosing. With that said, what would you suggest the split be...2U followed by 1.2U or would you do a larger first dose such as 2.4U followed by 0.8U?

Thanks!
 
I'm thinking 2.2 and 1 unit might be easiest. That is roughly a 2/3 : 1/3 balance.

If you have been using a sliding scale, you'll want to go with very stable dosing until you establish if this works for your cat with this insulin. Please monitor frequently; if possible, do a curve every 2 hours or a mini-curve every 3 hours.

Mark very clearly on your spreadsheet when you start this, possibly use 2 lines or add a column for each 2nd dose (am and pm).

One thing that may happen is that the nadir may not be as low. This is because you will have 2 smaller amounts of insulin separated by an hour, rather than 1 large amount, each having a nadir of its own. Testing will show you if that is true. If it is, then you will very carefully tweak the doses until you find what works best for your cat. You may find that a slightly longer interval than 1 hour may work better, too - maybe 1.5 or 2 hours.

Whatever you decide to do, test on a day you can be ther and be prepared should he go lower than expected.

If you want to return to twice daily dosing, reduce the total amount given as you will be superimposing the nadirs.
 
Well, Abernathy is really throwing me a curve ball...I just tested and his PMPS was 232 (I retested just to check and it was 224). I've never had one that low before. So now I don't know what to think :o

Thank you for the split dosage information. I guess I will hold off on that until I figure out what is going on. But, this information will be great to have as a back-up should I need it.

Thank you again as I really appreciate the help.
 
Of course. They do seem to know when we plan a change. What are you thinking? I'd say definitely less. If you can get at least a before bed test, maybe 2.8 or 3?
 
Last night since he PMPS was so much lower than normal, I only gave him 1/2 of his usual dose as I was scared of him dropping too low during the middle of the night when I wasn't around to monitor (I've never had this issue, so I was a little nervous not knowing how he'd respond). Of course this morning he was running high (531) at his AMPS. So, I guess I am going to see what happens over the next few cycles, regroup and go from there. It really kind of makes me laugh that he decided to switch things up on me right when I was ready to take action ohmygod_smile :lol:

Thanks again for the support and advice!
 
It would sure be nice to know why that cycle was so nice. Both preshots were better than normal. Anything different about yesterday - kind of food/amount/excercise or lack of it?

So next time when you get a yellow preshot, (optimism :-D )you can up the dose a little.
 
Sue and Oliver (GA) said:
It would sure be nice to know why that cycle was so nice. Both preshots were better than normal. Anything different about yesterday - kind of food/amount/excercise or lack of it?

So next time when you get a yellow preshot, (optimism :-D )you can up the dose a little.
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I gave it some thought and yesterday was just like any other day...same routine, same food, etc. The only difference started the night before where I reverted back to feeding small snacks at +3, +5 and +7. I continued this during the day as well. But, when I was previously doing this, I never saw numbers like yesterday. It's so strange :o

I'll see how the next few cycles go to see if I get any replication. If not, I guess it was just a fluke and I'll be back to trying another approach. :YMSIGH:

But, in the event that I do get a yellow pre-shot number, would you suggest just giving a full insulin dosage?? It obvious that the 1/2 dosage was not enough. I was just worried as I know when he is in the 500s, a full dosage brings him down into the 100s at nadir which is more than a 50% drop.

Thanks again!!
 
If your preshot is 50% lower than usual (which that one was) and near 200, I'd definitely reduce from the usual dose. Maybe not 50% less, maybe 30%? It's one of those that you just have to try and see how it goes. Last night it looks like the dose was a little too low so a little more next time.
 
Sue and Oliver (GA) said:
If your preshot is 50% lower than usual (which that one was) and near 200, I'd definitely reduce from the usual dose. Maybe not 50% less, maybe 30%? It's one of those that you just have to try and see how it goes. Last night it looks like the dose was a little too low so a little more next time.
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Great suggestion. I'll try that the next time he is lower. Yesterday he ran in the 500s for both the AMPS and PMPS, yet was in the low 300s this morning. Goodness he really keeps me guessing confused_cat

Thank you for the advice.
 
Well, I decided to up his dosage again and for the first time ever, I've seen greens :mrgreen: :mrgreen:

Funny how getting a certain color could make me so happy....I guess it's because I've been working for it sooooo hard to achieve it. But, I am sure he'll enjoy throwing me yet another curve ball after this. That seems to be what he does best . :lol:
 
Sue and Oliver (GA) said:
Green is a lovely color. Looks like he could be lower for pmps or have a big jump. Do you have a game plan?
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Well, I just tested and his PMPS was 244 which was lower than his AMPS. I think that I am going to do as you previously suggested and drop his normal insulin dosage by 30% and see how that goes. It's all such a guessing game....
 
Well...per the norm with Abernathy, he's back to confusing me ohmygod_smile His 'greens' lasted exactly one day. He is back to running high and I did a curve yesterday which it showed he never went below the 220's. I just don't know what to think :? Nothing has changed...same food, same insulin, same schedule, etc.

Now, I'm not sure what to do....
 
Hmmm. I am wondering if there is a pattern. He does seem (at least sometimes :mrgreen: ) to react right away to an increase in dose, have some better numbers, and then have a few higher cycles. I don't know if he has a delayed bounce response or whether I am just seeing things (or trying to...)

He still is dropping about 50%, regardless of whether his preshot is higher or lower. And with the higher preshots, he does have room to drop. How about increasing the amount on those high preshots by .25 or .5 (depending on how you feel about it and whether you can sure test that first cycle) and leave the amount you are giving on lower preshots alone?
 
Sue and Oliver (GA) said:
Hmmm. I am wondering if there is a pattern. He does seem (at least sometimes :mrgreen: ) to react right away to an increase in dose, have some better numbers, and then have a few higher cycles. I don't know if he has a delayed bounce response or whether I am just seeing things (or trying to...)

He still is dropping about 50%, regardless of whether his preshot is higher or lower. And with the higher preshots, he does have room to drop. How about increasing the amount on those high preshots by .25 or .5 (depending on how you feel about it and whether you can sure test that first cycle) and leave the amount you are giving on lower preshots alone?
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So, what would be the 'higher' preshot cutoff point...500 or greater? 450+? It's worth a try.

I guess if that doesn't work, then I will try the suggestion of splitting dosages.

Thanks again for the advice!! :-D
 
I have been following this post, and Abernathy's situation looks so similar to Hannah's. We also don't see much of a pattern that can be explained, and just when I think I have spotted something, it changes. Just when I plan to up her dose, she quits eating, or she manages some nice blues, or she has a very long cycle and is too low to comfortably shoot. Once the plan is cancelled, up she goes again, higher than a rocket and a new batch of confusion begins. So frustrating, isn't it?! I could use some suggestions and help on her feeding times and amounts, but I will start a new post in the Main Forum on that. In the meantime, best of luck with Abernathy. Hope you start to see patterns that will successfully steer you toward those beautiful greens.
 
Blamethecats and Hannah said:
I have been following this post, and Abernathy's situation looks so similar to Hannah's. We also don't see much of a pattern that can be explained, and just when I think I have spotted something, it changes. Just when I plan to up her dose, she quits eating, or she manages some nice blues, or she has a very long cycle and is too low to comfortably shoot. Once the plan is cancelled, up she goes again, higher than a rocket and a new batch of confusion begins. So frustrating, isn't it?! I could use some suggestions and help on her feeding times and amounts, but I will start a new post in the Main Forum on that. In the meantime, best of luck with Abernathy. Hope you start to see patterns that will successfully steer you toward those beautiful greens.
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Thanks for the encouragement. I appreciate it. Yes, it's incredibly frustrating angry(2)_cat I want to be able to 'fix' him, yet I can't even figure out a pattern to his test results. Thankfully, he's incredibly sweet and doesn't mind all the sticking and poking that I do. So I guess I'll continue on with what is appearing to be a marathon bcatrun_gif
 
it's incredibly frustrating angry(2)_cat I want to be able to 'fix' him, yet I can't even figure out a pattern to his test results. Thankfully, he's incredibly sweet and doesn't mind all the sticking and poking that I do. So I guess I'll continue on with what is appearing to be a marathon bcatrun_gif
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You don't know how many times I've said those exact words about Hannah (also a very gentle, patient, and tolerant kitty)! I so want to make her better. Even some progress would be encouraging, wouldn't it? And just seeing some sort of pattern would seem like a real breakthrough. Just want you to know that while you are marathoning, we are dancing right alongside you, so you are not alone.

Best wishes. cat_pet_icon
 
I wish I had some ideas for you. Clearly, he drops for nadir into decent ranges, but is too high for preshots. And he is getting up into the dose levels where we wonder about high dose conditions.

Have you looked at this thread on high dose conditions? Do any of the symptoms sound like him?


http://www.felinediabetes.com/FDMB/viewtopic.php?f=12&t=375

You might try one of the depot insulins. If ProZinc is just not lasting long enough, they might last longer. If you consider one, I'd consider Levemir. If he is going to need 3-4 units per shot, it is thought to sting less at the higher doses.
 
Sue and Oliver (GA) said:
I wish I had some ideas for you. Clearly, he drops for nadir into decent ranges, but is too high for preshots. And he is getting up into the dose levels where we wonder about high dose conditions.

Have you looked at this thread on high dose conditions? Do any of the symptoms sound like him?


http://www.felinediabetes.com/FDMB/viewtopic.php?f=12&t=375

You might try one of the depot insulins. If ProZinc is just not lasting long enough, they might last longer. If you consider one, I'd consider Levemir. If he is going to need 3-4 units per shot, it is thought to sting less at the higher doses.
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It seems like he is getting worse pre-shot numbers (especially the PMPS) the higher I go with the dose of insulin. I'm just not sure what to think. I almost wonder if I should lower the dose? Or try the split dose method mentioned above? Not exactly sure what I'm going to do. I still have some ProZinc to finish, so I've got a little time to figure out if I want/need to switch insulin.

And thank you for the link about high dose conditions. I've reviewed it and he just doesn't seem to exhibit any of those symptoms, but I guess anything is possible :-|
 
The curve you did suggests the ProZinc starts wearing off around +8 and is out at +10, leaving about 2 hours of uncontrolled glucose. A dose of 4 units does get him down to a decent number, but its like holding a cork underwater. The minute you let go, up it pops.

If you're going to stick with the ProZinc until its finished, the idea I mentioned previously might help smooth out the numbers a bit - giving a main dose, then 2 hours later, giving a minor supplement or splitting it in half and shooting the halves 2 hours apart.

If you can get Levemir or Lantus, I think that may help considerably. In the US, you'll want a prescription for the pens which have 3 mL of U-100 insulin, ie 300 units. If you live close to Canada, driving up there will save you a lot of money (well, after getting a passport!). Some Canadian pharmacies will ship to the US.
 
BJM said:
The curve you did suggests the ProZinc starts wearing off around +8 and is out at +10, leaving about 2 hours of uncontrolled glucose. A dose of 4 units does get him down to a decent number, but its like holding a cork underwater. The minute you let go, up it pops.

If you're going to stick with the ProZinc until its finished, the idea I mentioned previously might help smooth out the numbers a bit - giving a main dose, then 2 hours later, giving a minor supplement or splitting it in half and shooting the halves 2 hours apart.

If you can get Levemir or Lantus, I think that may help considerably. In the US, you'll want a prescription for the pens which have 3 mL of U-100 insulin, ie 300 units. If you live close to Canada, driving up there will save you a lot of money (well, after getting a passport!). Some Canadian pharmacies will ship to the US.
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I started the split dosing this morning. I'll start a new thread in a few days since this one is getting so long. I'd love to get your feedback if you get a chance.

As for the Levemir, just for my own knowledge so I can research the price, do you get one pen at a time or multiple? Just curious since there are so many units per pen. If you have to buy them in a pack, do you ever run the risk of some of the pens expiring before you can use them?

Thanks for all of the advice!

Thank you for all of your advice.
 
You'll want to get 1 pen at a time, due to the cost. If you're close enough to Canada and have a passport, I'd go there to get it as it'll be much less expensive than in the US.

There are some mail-order Canadian pharmacies which will ship and still come out less expensive than the states.

A thought - to help see it on your spread sheet, maybe use a 2nd line for the 2nd dose and add the time lag in the notes section.
 
One last question...do I need to be feeding my cat prior to his 2nd insulin shot. I am giving the 2nd shot 2 hours after the 1st (main) dose. I just happened to think about that and was wondering if I need to adjust his snack schedule which is currently +3, +5, +7 after 1st (main) dose.

Thanks again!
 
I'd keep that the same -1 change at a time, so you can be sure any impact is due to the altered dosing.
 
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