12/16 Quintus AMPS 356 PMPS 340 +4.5 94 +6 221, I think I can sleep

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I'm still impressed you can go from an almost all red am cycle to an almost all blue pm cycle. I hope the bounce is short lived and you start seeing those nice numbers again soon!
 
Stephanie & Quintus said:
+2 356 BTB
Could it be a meter issue?
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I forgot about that, could be, maybe you can flag in your SS when you switched meters (put using different AT meter or something in a blank cell) so you can keep an eye on that. The trends should indicate after a few more cycles. Do you have control solution you could test it with? And did you make sure it's coded correctly according to what the strip bottle says? But until proven otherwise, I'm choosing to believe Quintus was really blue last night (or that the meter you had before was the wonky one)! ;)
 
So, today was all nice purple, with a tinge of red at +10. Wondering what to expect tonight! Thank god it's the week-end. I won't be able to stay up until 2am tomorrow night though...
 
The meter seems okay so far, the cycle last night is not unlike the one from the night before, save one he went back up after yellow, and the other he kept dropping. That wouldn't be a meter issue, IMO, that's Quintus. I wonder how human blood would read on the AT? That's how some people check their meter for accuracy is to test themselves. :p

Thanks for putting it in the cell, I found your little flags, but I look at the US sheet and they don't show up on that. Hoping you see some nice numbers today! :cool:

I went to see his SS and it took me to a Facebook page instead (clicked the wrong link). He sure is a beautiful kitty! And he doesn't show his age one bit! :cat:
 
He came down again for the PMPS, back in the purple. A drop and a half oozed out of the pen once I'd given the shot, so it looks like he might unwittingly have gotten a dose reduction :-/ (my estimate: 0.5UI)

Can I wait until +2 to test? Or maybe even +3?
 
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If all things go according to plan (which they don't and ECID), +1 and +2 give you a heads up and +2 to +3 is supposed to be when the onset of the new shot is.

Example of an ACTIVE, but NOT necessarily typical Lantus cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

An active Levemir cycle will have an onset at approximately +4 and a nadir around +8 - +10. However, please keep in mind every cat is different (ECID). Data collection will offer you a better picture of YOUR cat's response to either of these insulins.

Initially, don't expect to see "active" cycles after every single shot whether you're using Lantus or Levemir. Chances are, your kitty had diabetes for some time before diagnosis. It requires time for kitty's body to become used to dropping into lower numbers than their bodies have become accustomed. Don't expect immediate results! Regulation takes time and patience.
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@Stacy & Asia regarding the insulin depot, the article you linked to really focuses on what the depot looks like and it's physical form. What I'm interested in is the cinetics of how it transforms into insulin in the bloodstream. I get the mechanism, but no sense of time.
 
+3 is 140
I hope he doesn't slide down like he did yesterday.
Going to add a little more HC kibble to his food mix and get him to eat.
Other suggestions?
I guess I'm not going to bed yet. Will nap one hour and check in an hour?
 
Stephanie & Quintus said:
+1 101 -- reminder, I am using a pet meter. I'm just a little worried now (understatement).
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I think you mean +4 is 101. That's a lovely number. Your nadir last night was at +6 and that's typical of Lantus. There's no guarantee it'll be exactly +6 tonight but I wouldn't worry too much yet. Get a BG hourly. This is a great data-gathering exercise if your nerves can take it. The goal is dark green at nadir but you want him above 68. You could try a teaspoon or so of low carb wet food to "steer" the BG away from the depths (lime green) if you're very uncomfortable.
 
Blues are good & safe :) If he goes into the greens than I would be a bit more concerned about eating. Check out my Merry's spreadsheet. He went into greens for the first time the other night & I was happy to see that finally. Greens are what we're aiming for :) When I checked Merry's blood at 3:00am that night & saw he was in the greens I just made sure he had a snack of his regular food so he didn't drop too low (he hadn't eaten the snack I put out for him when I went to bed so that's what I got him to eat at 3:00 in the morning) & that did the trick. I didn't use high carb food although I do have it on hand just in case.
 
Hmmmok, found this: http://petdiabetes.wikia.com/wiki/Blood_sugar_guidelines

"5: A commonly cited minimum safe value for the lowest target blood sugar of the day when insulin-controlled." -- means there isn't a huge margin left.

I'm worried because although I'm here today and tomorrow to monitor him, Mon/Tues I'll be gone a full 12h for work. I'm also not done transitioning him to wet LC food yet, so wondering if I need to stall that transition until next week. Or should I decrease the dose a little to give us wiggle room for safety while I continue the food transition and am at work? I really won't be able to be staying up until +6 on work days, I'll just collapse :-(
 
LuanneP said:
Blues are good & safe :) If he goes into the greens than I would be a bit more concerned about eating. Check out my Merry's spreadsheet. He went into greens for the first time the other night & I was happy to see that finally. Greens are what we're aiming for :) When I checked Merry's blood at 3:00am that night & saw he was in the greens I just made sure he had a snack of his regular food so he didn't drop too low (he hadn't eaten the snack I put out for him when I went to bed so that's what I got him to eat at 3:00 in the morning) & that did the trick. I didn't use high carb food although I do have it on hand just in case.
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Yes, but you're using a human-calibrated meter, not a pet-calibrated one, which changes things, right?
 
Stephanie & Quintus said:
Corrected, +4!

Unless I am deeply mistaken, normal BG for a cat is 1-1.2 g/l -- times 5.5 to get mmol/l, what my meter is measuring, so below 5.5 is technically veering into hypoglycemia territory. Am I mistaken?
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Technically, yes. The guideline "take action" number of 68 (or 3.8) is derived from the TR protocol that has remission as its goal. The thinking is that getting BG down into these low numbers can help heal the pancreas. It's an aggressive protocol and requires more monitoring and frequent dose changes. The 68 "warning" number is a guesstimate of what a pet meter might read in comparison to the 50 given for a human meter. This boundary of 50 on a human meter was derived from the Roomp and Rand study in combination with a protocol used by a German FD group. They form the basis of the TR protocol. You might be more comfortable following SLGS which is more forgiving with wider margins, especially with your schedule. Maybe read it to see if it fits better with your circumstances?

Here's what I can say based on treating my very unpredictable cat for two years now:
  • there's art as well as science in working out a good dosing regimen for a particular kitty
  • it's OK to have different goals than others here - regulation instead of remission, better regulation versus no regulation, etc.
  • living organisms can defy all attempts to quantify responses to FD treatment - they WILL surprise you!
  • you'll have to live with a degree of uncertainty a lot of the time but this lessens as you gather a lot of BG data.
This is a hard thing to deal with and there's a lot to learn. It's important to decipher your own kitty's responses because Every Cat Is Different (ECID). The TR protocol/SLGS guidelines are very helpful to get you started, to sort out an dosing issue, etc. Trust them but trust your gut too. :)
 
Thanks, @Kris & Teasel . At the moment my ambition is to have Quintus stay, say, at least below 350, or ideally renal threshold, for a significant number of hours per day. I'd love to be able to hope for remission but seriously, given my schedule and how battered poor Quintus's pancreas looks on the echography, I think it's a bit too optimistic just right now.

I've looked at SLGS but I'm pretty sure Quintus is on too high a dose, as we upped it fast, and he was initially on 100% HC dry food. I need to be able to sleep, and go to work without worrying myself sick that Quintus might be going into hypo when I'm gone. My first objective is to finish transitioning him to wet LC food, which is going to take a few more days, or maybe a week, given the soft stool he produced today.

So, at this stage I'm neither doing TR nor SLGS, because I jumped in somewhere in the middle of trying to figure my way to dose with my vet.

I think it would be safer to lower his dose by 0.5 tomorrow so that I can continue the food transition without staying up all night all week :-/
 
Stephanie & Quintus said:
Yes, but you're using a human-calibrated meter, not a pet-calibrated one, which changes things, right?
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The spreadsheet you're using is color coded for a pet meter & blues are safe. The dark greens are safe too but you need to be more aware when they are in the dark greens & take the steps to prevent them going lower if necessary. I didn't jump to high carb food right away, just made sure Merry ate & then tested him shortly after. His BG came up so I knew he didn't need high carb food at that moment.

According to this document: http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/
If you're using an AlphaTrak meter than Hypoglycemia is a concern when BG is below 65 mg/dL (3.6 mmol/L) for adult cats and dogs.
 
Stephanie & Quintus said:
Thanks, @Kris & Teasel . At the moment my ambition is to have Quintus stay, say, at least below 350, or ideally renal threshold, for a significant number of hours per day. I'd love to be able to hope for remission but seriously, given my schedule and how battered poor Quintus's pancreas looks on the echography, I think it's a bit too optimistic just right now.

I've looked at SLGS but I'm pretty sure Quintus is on too high a dose, as we upped it fast, and he was initially on 100% HC dry food. I need to be able to sleep, and go to work without worrying myself sick that Quintus might be going into hypo when I'm gone. My first objective is to finish transitioning him to wet LC food, which is going to take a few more days, or maybe a week, given the soft stool he produced today.

So, at this stage I'm neither doing TR nor SLGS, because I jumped in somewhere in the middle of trying to figure my way to dose with my vet.

I think it would be safer to lower his dose by 0.5 tomorrow so that I can continue the food transition without staying up all night all week :-/
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Actually, Quintus is giving you a lovely response to this 3 u dose. However, with the dark green this early in the cycle, I'd give him a small snack of wet food (low carb) and retest in 30 minutes or so.
 
Kris & Teasel said:
Actually, Quintus is giving you a lovely response to this 3 u dose. However, with the dark green this early in the cycle, I'd give him a small snack of wet food (low carb) and retest in 30 minutes or so.
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He has had a good chunk of his "normal HC/LC transition mix" at +3, at +4, and again at +4.75... So those numbers are with me feeding him. So was last night.
 
LuanneP said:
The spreadsheet you're using is color coded for a pet meter & blues are safe. The dark greens are safe too but you need to be more aware when they are in the dark greens & take the steps to prevent them going lower if necessary. I didn't jump to high carb food right away, just made sure Merry ate & then tested him shortly after. His BG came up so I knew he didn't need high carb food at that moment.

According to this document: http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/
If you're using an AlphaTrak meter than Hypoglycemia is a concern when BG is below 65 mg/dL (3.6 mmol/L) for adult cats and dogs.
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Thanks! I didn't know the spreadsheets were color-coded differently. That's reassuring. Thanks also for the reference with the AT.
 
Stephanie & Quintus said:
I've looked at SLGS but I'm pretty sure Quintus is on too high a dose, as we upped it fast, and he was initially on 100% HC dry food. I need to be able to sleep, and go to work without worrying myself sick that Quintus might be going into hypo when I'm gone. My first objective is to finish transitioning him to wet LC food, which is going to take a few more days, or maybe a week, given the soft stool he produced today.
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SLGS accomodates the feeding of some dry food (even as you work toward removing it), allows dose reductions at higher BGs (90), recommends holding a dose longer and suggests a weekly curve. These things should make it somewhat easier for you to fit testing into a busy schedule, reduce some of your worry about a hypo while you're away from home, etc. It might be a better fir for you.
 
Unless he drops lower than the dark greens you have already you wouldn't reduce his dose with SLGS. You've encountered the problem that goes with aiming at close regulation of BG: are you able to control the trajectory of the BGs with feeding throughout a portion of a given cycle? That's how some people are able to get kitty to and stay in near ideal BG ranges. It isn't always possible in every set of living circumstances. You have to work out what you can do on a regular basis and it can involve compromises.
 
Kris & Teasel said:
SLGS accomodates the feeding of some dry food (even as you work toward removing it), allows dose reductions at higher BGs (90), recommends holding a dose longer and suggests a weekly curve. These things should make it somewhat easier for you to fit testing into a busy schedule, reduce some of your worry about a hypo while you're away from home, etc. It might be a better fir for you.
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Yeah, I think SLGS is better for me. I'm just not sure how to manage the fact I'm already at 3ui which IMHO is way too high once we'll have switched to LC food (look at December 5th, he was down to 76 AMPS because he hadn't eaten much during the previous 24 hours, and he'd only had 2ui the evening before, and 1ui in the morning -- and only 1ui once a day the previous days).

So I need to make a "bridge" towards SLGS somehow now, knowing that on Mon/Tues I need things to be "safe". Any suggestions on how to do this most welcome.
 
Kris & Teasel said:
Unless he drops lower than the dark greens you have already you wouldn't reduce his dose with SLGS. You've encountered the problem that goes with aiming at close regulation of BG: are you able to control the trajectory of the BGs with feeding throughout a portion of a given cycle? That's how some people are able to get kitty to and stay in near ideal BG ranges. It isn't always possible in every set of living circumstances. You have to work out what you can do on a regular basis and it can involve compromises.
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Thing is, when I change his food mix tomorrow or Monday he's going to go lower :-(
 
Yes, you're doing two things at once that can put downward pressure on BG, giving a higher insulin dose while removing higher carb food from his diet. You could try lowering his dose to 2.5 u (or 2 u?) as you continue/complete the food transition. Once that's finished or you arrive at whatever mix of foods works going forward, your BG data will be your guide to next steps. What lower dose to give is guesswork but you don't want to go too low nor do you want to change the dose frequently. Settling at a dose (even though it seems too high) has resulted in some real progress recently.

What proportion of his diet now is low carb wet food? How much longer do you think the food transition will take? Do you think he'll accept a diet of only low carb wet food or will he demand some kibble? The goal is only LC wet food but some kitties are adamant about wanting some dry.
 
@Kris & Teasel so currently he is getting roughly 50/50. Four days ago was real 50/50 but it turned out to be too much food for him. I therefore took out some of the kibble to reduce the portion size, so maybe it's more 60/40. Today I gave him a bit more of the wet food. (Sorry thinking out loud, tired.) So today, yeah, he got half of what he's in theory supposed to eat in wet food, but it may be closer to 75% of what he'll really eat in the end. And the rest in kibble.

He will happily eat only wet food, that won't be a problem. The reason I'm going slow is that when we transitioned him brutally upon diagnosis, he ended up having diarrhea. As he's blind and not that stable on his feet anymore, by the time he had pooped in the litterbox 3 times in a row during the night, he stepped in it, and then promptly jumped on the bed and -- did I mention he's blind? -- put a hind paw full of poop straight in my face as I was sleeping. It was 4 am. It woke me up real quick.

So as we transition, I'm monitoring his poop. It's been OK so far, but he went twice today with the second time being a little on the soft side, so I don't want to rush things.

I would definitely feel safer lowering to 2.5u to have a bit of wiggle room for the food transition. My guess is that by the end of next week it's a done deal.
 
:eek: Poo foot on face!! I think going slower on the food transition is a good idea for sure.

OK - try 2.5 u starting next dose. Don't change it unless he drops to 90 or lower. I'm basing that on SLGS. Try not to fret if you see high numbers. If you can accomplish the food transition over the course of the week then you'll be ready to follow SLGS guidelines about holding or changing a dose. :)
 
Kris & Teasel said:
OK - try 2.5 u starting next dose. Don't change it unless he drops to 90 or lower. I'm basing that on SLGS. Try not to fret if you see high numbers. If you can accomplish the food transition over the course of the week then you'll be ready to follow SLGS guidelines about holding or changing a dose.
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Yeah, that sounds like a plan I feel comfy getting on board with. Thanks a lot for helping me think through this and advising me. Now that I've seen that he can go lower than red and black, I'll worry less. I've seen Lantus works! Need to stock up on syringes and find my reading glasses... (I have a handful but not enough to last the week)
 
Stephanie & Quintus said:
Yeah, that sounds like a plan I feel comfy getting on board with. Thanks a lot for helping me think through this and advising me. Now that I've seen that he can go lower than red and black, I'll worry less. I've seen Lantus works! Need to stock up on syringes and find my reading glasses... (I have a handful but not enough to last the week)
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Glad to help! So much of this is mind set and having a plan that's workable helps with that. :) Your confidence level and ability to handle ambiguity will develop over time - promise!
 
Kris & Teasel said:
Your confidence level and ability to handle ambiguity will develop over time - promise!
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Yes, I'm sure it will! I'm trying not to push myself into too much stress as I'm a bit wobbly right now (recent burn-out and new job, been ill all week, x-mas coming up, fear of losing Quintus... I want to make sure I stay operational!)

I'm happy to have my "bridge to SLGS" and I'll go ahead with that method and decide at some point if I really want to aim for tight regulation or if I'll just be happy to coast in the blues for a bit.
 
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