11/25 - Alphyne - PMPS @ 224, +6 @ 510 - thoughts?

[bobjoh]

(previous) 10/22 - Alphyne 438@AMPS - today was supposed to be curve day | Feline Diabetes Message Board - FDMB

Hi All.

Well, today was a weird one. She was doing quite well, and her PMPS was in the low 200s. Usually when she's in that range, I know I'm going to have an active night, as she has a tendency to go blue or even green shortly after. But this time. she went up, and is now in the 500s!

Today is actually curve day, and I was expecting her to need an increase, but I was not expecting numbers in the 500s. She's only been in the 500s twice...both times in the last month.

I was trying to get back to curves every 7 days, but it seems like she's bouncing more than normal, so I try to wait until I know she's not in a bounce. The curves have been about every 10 days instead of 7.

She was getting on a roll at the end of last month, more blue and some green, but then dropped down to a 43 so I did a dose reduction. Since then she's been struggling in the pinks and yellows. She occasionally bounces into the 400s, but I can usually tell when those are going to happen.

The 500s are a huge cause for concern, and are completely unexpected.

She does have an appointment on Monday for her yearly checkup, and will get blood work and xrays, etc. I am going to a new vet, so maybe he'll have some new insights.

Anything I should have him check for? After 9 months on insulin, I was expecting her numbers to be getting better not worse. Any thoughts? Thanks, as always!

 

[FrostD]

Possibly a bounce from a lower number in the AM cycle?

I'm not familiar with your circumstances, is there a reason you are holding doses as long as you are?

Is there a reason you feed the glycobalance? It's fairly high in carbs.

I think you're just fighting some glucose toxicity and could benefit from increasing a little more quickly.

As for other stuff, I would let the labs lead the way. See how the standard wellness panel comes back.

 

[bobjoh]

I'm not familiar with your circumstances, is there a reason you are holding doses as long as you are?
Is there a reason you feed the glycobalance? It's fairly high in carbs.

I'm hold a day or two extra sometimes because she's always bouncing. I've been trying for 7 days, but if you look at her numbers, she's almost always bouncing on day 7. I've been waiting for the bounce to break before doing a curve. Maybe I shouldn't wait to break the bounce, but it seems counterintuitive to do a curve when I know her numbers are artificially inflated? She was on 2.25 for quite a while since her nadir was always between 60-150 (modified reduction point). I don't think she's ever going in to remission; I just need her on a stable dose. I was hoping that was 2.25, but then she bottomed out at a 43 a few weeks ago, so I've been trying to get her stable since then.

It's been an ongoing struggle with wet food; I can't get her to eat it consistently. Glycobalance is fed sparingly. (All the recommended low carb kibbles make her throw up, and always incur a trip to the vet.) I've noticed it doesn't spike her blood sugar, though, even with it being high in carbs. I stay with SLGS because of the food situation, unfortunately.

 

[tiffmaxee]

You are correct that doing a curve while bouncing won’t give you the overall nadir. But you are getting more tests than required with SLGS. Looking at your ss I think you have room to go up to 2.5. The nadirs are over 150. When are you feeding the glcobalance? I’m guessing at night which is causing higher numbers during the day? If that is true it’s part of the reason why numbers are higher during the day.

 

[bobjoh]

But you are getting more tests than required with SLGS. When are you feeding the glcobalance? I’m guessing at night which is causing higher numbers during the day?

I usually only test 4 times a day; the PS and then @ +2 or 3. If she's acting weird (she meows at me when she feels off), or if she has an odd number I've been testing more often, and her numbers have been really odd lately, hence more tests. Luckily, she doesn't seem to mind the tests at all.

She's fed glycobalance at the same times AM and PM (just a tablespoon or a half tablespoon at a time), so sadly that doesn't explain the higher day numbers.

 

[FrostD]

I'm hold a day or two extra sometimes because she's always bouncing. I've been trying for 7 days, but if you look at her numbers, she's almost always bouncing on day 7. I've been waiting for the bounce to break before doing a curve. Maybe I shouldn't wait to break the bounce, but it seems counterintuitive to do a curve when I know her numbers are artificially inflated? She was on 2.25 for quite a while since her nadir was always between 60-150 (modified reduction point). I don't think she's ever going in to remission; I just need her on a stable dose. I was hoping that was 2.25, but then she bottomed out at a 43 a few weeks ago, so I've been trying to get her stable since then.

It's been an ongoing struggle with wet food; I can't get her to eat it consistently. Glycobalance is fed sparingly. (All the recommended low carb kibbles make her throw up, and always incur a trip to the vet.) I've noticed it doesn't spike her blood sugar, though, even with it being high in carbs. I stay with SLGS because of the food situation, unfortunately.

Makes sense!

I agree there's room for an increase.

Do you have schedule flexibility for curve day? Because if it were me, I'd do a curve whenever she has a lower than normal preshot and the +2 shows a bit of a drop, sometime between day 5 and 7. Like at this dose, I'd have done it Day 6; prior dose I'd have done on Day 5. It doesn't follow SLGS as written obviously, but you test enough that I'm not really worried about that (we'd just note in it signature and in SS header and remarks).

 

[bobjoh]

Do you have schedule flexibility for curve day? .

I do have flexibility, and that's a good idea. I'll keep my eyes peeled for numbers like you mentioned. At least I'd get better curves, even if I'd end up holding the dose. Thanks so much!

 

[FrostD]

I do have flexibility, and that's a good idea. I'll keep my eyes peeled for numbers like you mentioned. At least I'd get better curves, even if I'd end up holding the dose. Thanks so much!

No problem!

Just any time you deviate from protocols as written, I'd note it in SS and signature...or you'll get a billion questions