12/15 carbonel's AMPS 385

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CarolCarbonel

Member Since 2014
Hi,
I have been coming to this message board on and off for 5 years now. I just have not been able to stabilise Carbonel's blood sugar for 2 years now and I am losing heart. :cry: What I seem to be experiencing at the moment is a big drop in her blood sugar late in the afternoon. This seems to carry on or overlaps with her evening shot dropping her still lower post evening shot. I cannot stay up till the early hours watching her, so I give her some food to stop her going hypo, although she can help herself outside.
Each time I increase her insulin I seem to get very high AM PS's. If I decrease her insulin her AMPS is lower but she does not
drop to the AMPS I was getting a couple of years ago.
She hunts and this obviously affects her readings. At the last visit to the vet they said she was very well covered, unlike a diabetic cat. However she has got a bit thinner lately.
Carbonel is 14 years old, has been diabetic 5 years and is fed Nutriment (a raw cat food available in the UK).
The problem seems worse every winter - is it possible the colder weather affects her bloods?
I measure her insulin with a caliper now.
Can anybody give me any advice, please?
Thanks so much,
Carol

https://docs.google.com/spreadsheet/ccc ... sp=sharing
 
Hi Carol. I find that your spreadsheet is really slow to load. Google is having issues lately, but one of the reasons I start a new copy of the World SS each year is that I find if it gets too long, it also gets very slow. Just something to think about as we approach the new year. Now that I've got it open, I see that the units column is empty most of the time. I can't comment on the dosing without it.

Another questions, what type of meter are you using, pet specific or human? That makes a difference in what the numbers mean. And I presume you are using Lantus? Some people here are using Levemir, so just checking.

It does look like Carbonel could be going lower at night and is bouncing a bit during the day, then doing a mini bounce in the morning. My Neko really likes to do that too. I don't stay up with her all night, but I get a before bed test and then based on that, I may set an alarm for a few hours later to get a quick test. If you are on Lantus, the +2 test is a really good one. If Carbonel's +2 test is significantly lower than the preshot number, then there's a good chance of an active cycle, and that would be the night you want to get a quick middle of the night test. Another alternative if you can't do that, is to get an automatic feeder. If you give food before going to bed, there's a chance it's being eaten right away and not there when she needs it. An automatic feeder allows you to set the timer for mid cycle time. In the mean time, a before bed test is really important to try to find out if she is going too low at night.
 
Hi Wendy,
Thank you for your response.I have included the units for 2014 only as these are measured with the caliper. I hope they are still there as they keep disappearing.
I am using a accu chek aviva for humans and Carbonel is on Glargine (Lantus?)
I have suspected for sometime that she goes too low at night as you suggested. How would I remedy this matter?
I have often checked her blood around +4 after the pmps and it has been quite low. How much is significant lower? The problem with the feeding is that I have 4 other cats who will eat the food in the timed feeder.
I will start a new spreadsheet in the New Year, the loading really is a nuisance.

https://docs.google.com/spreadsheet/ccc ... sp=sharing
Thanks again,
Carol
 
ok, thanks. there's nothing in the dose amount column in the mornings, and i was thinking maybe your issue was from only giving one shot a day.

It's a little hard to know how to advise you. After 5 years, you no doubt have a system down that works for you, but I'm not sure what to suggest about the dose. Lantus dosing is based upon how low a dose is causing a cat's BGs to go. The low point of the Lantus cycle is typically somewhere in the middle of the time between shots, maybe +3 to +8, depending on the cat. When punkin was alive, I tested to try to catch that low point so i could be confident how low he was going. You don't have that information, so it becomes a little tricky to figure out how to proceed.

I think if i were you, when I thought i might need to increase the dose, I'd get at least one mid-cycle test in every cycle for at least 3 consecutive days, both am cycle and pm cycle, and then make my decision based upon what I learned from the data. I'd make an extra effort to get a test in the night cycle because so many cats go lower at night. The 2 recent tests that you do have in the night cycle are both the lowest tests of those days, so it's very reasonable to think that what Wendy is suggesting is true. However, going lower at night and having a bounce result doesn't necessarily mean that Carbonel is getting dangerously low at night. If he's mostly used to 200's, even 100's could potentially cause a bounce.

That's how I'd proceed, at least.

Jill wrote a post a while ago on the New to the Group sticky called: Should I Increase the Dose? Maybe that will have some helpful information for you.

Good luck!

julie
 
Thanks Julie. I seem to remember reading about the criteria for 1 shot of Glargine a day, but can't remember where that was. I can see I will have to get an early morning reading just to establish how low she is actually going.
Sorry I mislead you by not putting in the morning dose, as this was the same dose as the evening I did not include it.
Before feeding Carbonel the Nutriment raw food her nadir was generally mid afternoon. As I said this dropping late is a new occurrence.
Kind regards,
Carol
 
With cats, dosing with Lantus is typically recommended at twice a day, about every 12 hours. Cats have a fast metabolism and typically the duration of the Lantus' effects are somewhere between 8-12 hours. Going to one shot per day is usually only done in unusual circumstances, for example when a cat's pancreas is healing and the cat is near to going off of insulin. Otherwise it's generally most successful given every 12 hours. Maybe what you saw was in reference to humans, where the dosing is typically once per day.

Sometimes when the nadir has typically been about a certain point of the cycle and it moves, that can indicate that the dose needs to be adjusted. Sometimes it just moves and it doesn't mean anything, but if a cat typically has a late nadir and then begins having nadirs earlier in the cycle, that can sometimes be a heads-up that a dose reduction might be in the near future.
 
Hi Julie,
I think I have just found the answer to Carbonel's problems. I found this topic 'Shot Placement & Overlap' where somebodies
husband gave their cat its shot in the scruff of the neck. I recently found out that my husband does this as well, but I always shoot in the flank. He does the morning shot- hence the long duration and I do the evening- hence the overlap.
I am hoping that I can sort this out now. Will report back.
Kind regards,
Carol
 
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