? 12/10/2024 Mr. Pants amps 159 +4 83 +6 93 +11.75 191 +12 176

Shaved dose yesterday and got a much lower nadir. Came back up a little higher, but re tested after food and we were at 176. Maintained dose. Don't really understand what happened here.

 

Lantus has a depot so changes in a cycle don’t necessarily reflect the dose you just gave in reference to last night’s BGs.

Looks like he bounced but it’s hard to tell with no tests after +6. The 176 at +12 is within meter variance of 191. It takes at least 30 minutes for food to affect the BG

My concern is you are still dose-hopping. That just isn’t how this insulin works best.

Could you please put the date on today’s thread in the subject line and start with AMPS? I’m assuming you gave insulin with the 176?

 

Yes, the insulin was administered right before the reading of 176. SLGS states there should be a reduction with a reading under 90 mg/dl.

 

This sounds like you gave the insulin first and THEN checked the bg's. Is that correct?

 

BG was checked at +11.75 and the reading was 191....He was given food and after he ate I administered insulin and BG was checked at +12 giving me the 176 reading

 

Interesting developments

 

I couldn’t tell you were doing SLGs with the dose changes varying from 0.5u+ to 0.5u-. SLGS requires you hold the dose for a week before doing a curve unless the BG drops below 90. Then you take a 0.25u reduction which you should have done this morning. I’m glad you did it tonight.

The process for feeding and shooting at AMPS/PMPS is test, feed, shoot within 15 minutes. If you are stalling, which hasn’t been necessary, then you should not feed. I’m not sure why you are testing after you feed him.

He’s actually looking pretty good. Remember you will hold the 0.25u dose for a week u less he drops below 90 again. Don’t be tempted to raise the dose if the BG trends up….thats not SLGS.

 

87@+3 with reduction

 

I didn't want to reduce the dose because I wasn't sure he was dropping below 90. I did notice that every time I shaved the dose I got lower numbers at a more rapid rate. Im sure I should have reduced his dose a while ago. He just dropped below 90 again tonight. I feel like he has developed a hyperactive pancreas that is capable of preventing him from becoming hypoglycemic and very potentially has not needed insulin (or at least any significant amount at all) for some time. Essentially, chronically bouncing. I don't see how these numbers can be interpreted any other way.

 

I had been testing him immediately after eating because I just happen to catch him dropping right after his meals...I WAS stalling but I haven't been recently. I've been testing ten - fifteen minutes before meal and immediately after he finishes eating, right before I shoot ( because I just happen to catch him dropping right after meals....I suspected he was releasing his own indigenous insulin).

Its all very wacky

 

To comment on some of the parameters: It would seem impossible to tell whether or not he was dropping below 90 without essentially doing a curve most days.....which is what it seems like Im doing already. Had I not been, I wouldn't have caught it. Not to mention the fact that The first time he dropped below 90 it was immediately after I shaved the dose. So I may very well have not got below 90 had I not reduced it slightly. There is a fairly clear correlation between dose reductions / shaved doses and lower BGs reflected in this chart.

 

I guess the next step is to take another reduction tomorrow morning ....seems insane

 

What you're referring to as a "hyperactive pancreas" is for many cats a normal response to lower numbers. It's what we call a bounce. Bounces, while annoying, are a form of protection from low numbers. He's not consistently bouncing and Mr. Pants is clearing the bounce in a short period of time. I do disagree with your statement that your cat doesn't need insulin. If you take a look at the spreadsheets of members whose cats are on OTJ trials, you'll see a very different looking spreadsheet. The numbers are predominantly below 100. This is an example of one of these spreadsheets. Like Marje, I'd encourage you to stick with the SLGS approach and lets see how Mr. Pants does.

 

Hey Zach - nice to see Mr. Pants is doing well.

I suspect you are looking at the Lantus insulin as if it had in and out effects, and that's just not how depot insulins work.

I believe if you are referring as an example yesterday evening, those numbers are all within meter variance, and 15 minutes is not enough time for the carbs that he ate to influence the next test.

As Marje said, if you are following SLGS, you want to take the reduction immediately the next cycle after the drop under 90. Ordinarily since he dropped again under 90 last night, it would earn a reduction, but since you were late taking the reduction before from the pm cycle previously, and you stayed with 0.25u this morning and since you aren't feeding any dry, why don't you try and hold 0.25u for tonight and see if you get greens again. If he goes green tonight and drops under 90, then tomorrow morning I would reduce to 0.1u.



That would be my suggestion, but let's see if there are other opinions.

 

I didn't reduce his dose this morning because it just seems too quick. Besides, I don't have a really accurate way of measuring less than .25 u on the syringes Im using. I'm headed to Home Depot to pick up a set of calipers now. I have had him below .25 u BID before and he was doing great. We will see what his numbers look like today and go from there. Based on his numbers from last night we need to do another reduction according to SLGS protocol. While I may have speculated that he may not have needed insulin I was more or less just referring to the amount I had been giving him. He has done really well most of the last five years with less than .25 u BID so we'll see if we can get back there. I'm not shooting for remission necessarily, I just want him to feel good. He has improved immensely on a clinical and biochemical level in the last several weeks so we are on the right track. Thanks for your help

 

I won’t add anything because Sienna and Christie covered all the points I would have made.

 

So we are back up to 222 this a.m I feel like I should increase his insulin. I didn't...but I felt like I should have. I'm hoping that maybe he dropped too quickly yesterday and bounced. Maybe he did so because I should have taken the additional reduction? I got busy and missed my +2 check.

 

Since this is dated back on 12/10 you really should start a new thread with today's date and include a link to this thread for reference. Are you not able to do TR? It looks like you test enough for it.

 

I made a new post just now. TR protocols were requiring me to hold doses that I believe cause my cat to bounce and I am not typically around the house as often as I have been recently. How do I link the post?

 

copy the link in the browser then paste it onto your new page

 

Back up to 222 from what? 209? 181? You remember these are all essentially the same number, right? Most human meters have a variation of 20-25% (you can usually find this either in the manual or on their website or googling FDA approval of brand “whatever” glucometer or by calling their support line. For each number in your SS bracket it +/- by whatever percent variation your meter has. I sometimes take comfort in a trend within a cycle but i temper it with knowledge of my meter’s limits.

the fine points of tenth of a U increases or decreases are way above my skill level but it seemed like the meter variance got lost in the discussion.