12/20 - Gen, AMPS >400, PMPS >400

[Allie & Gen]

Yesterday

Last night's cycle came very close to dipping into blue, but it was mostly yellow and wound up red again by the end. We're on the seventh day of this 1.25u dose, and I'm not really sure what I'm looking at - we've had two fast dips into the green, but it's a very jagged up and down pattern, with most nadirs in the yellow. I don't know if I should hold this dose, consider an increase, or what.

This is where I really find SLGS rather confusing. He was on 1.25u, but then he went below 90, so I reduced to 1u. A week on 1u, and he never had a blue number. I increased back to 1.25u; he's had those two big dips, both of which went below 90, so according to SLGS I should already have decreased back to 1u, but that really did not seem right to me and I had at least somewhat tacit agreement from more experienced folks, so I held the dose. Since I have the Libre data, I don't need to perform a curve as such, though I suppose I could watch what happens today and go from there? (Looking at the whole week I have 2 nadirs under 90 and all the rest over 150.)

Any insight would be gratefully appreciated. I'm sorry if my failure to reduce earlier in the week disconcerts anyone, but I do stand by that, and I hope it won't dissuade anyone from sharing thoughts. I promise to take it all with a grain of salt, but also seriously. @Christie & Maverick @Sienne and Gabby (GA) @Wendy&Neko @tiffmaxee

I am going out for a chunk of today, so I won't be here continuously, but I'll stop in some. Thanks as always, friends. Wishing everyone a reasonably relaxed Saturday (possibly a tall order this time of year for some!) and a safe green surf to all your sweet cats.

 

[Allie & Gen]

Morning snuggles.

... I am concerned that he may be experiencing increased oral pain, based in part on discussion here last night. I watched him carefully this morning, and he seemed to begin moving very stiffly after eating his breakfast (and wasn't compelled to return for a mouthful of dry food when I set it out, after I was satisfied that he'd consumed the medicated portion of his wet food). He didn't hide this time, and was cooperative for his shot, but ... I found the change in movement striking. He had been all fluid grace when I first got up to start preparing his meal.

(If he is in increased oral pain, it's not stopping him from eating. He ate hungrily this morning, and even moreso last night, to the point that I had to put out a little extra before bed to make sure he'd have overnight snacks available, which isn't usually necessary. But it worries me for its own sake. This will be one of the things I focus on with the vet on Monday.)

 

[Christie & Maverick]

Morning Allie, I’m not ignoring your questions, but for me it takes time to formulate thoughts and I need to be out for a little bit here shortly. I’ll come back to you, and in the meantime one of the others whom you’ve tagged may offer a few suggestions as well. It’s a wee bit early yet for a few of them

 

[Allie & Gen]

Morning Allie, I’m not ignoring your questions, but for me it takes time to formulate thoughts and I need to be out for a little bit here shortly. I’ll come back to you, and in the meantime one of the others whom you’ve tagged may offer a few suggestions as well. It’s a wee bit early yet for a few of them

I don't feel ignored! Please take your time. I needed to get it all out while I was still home with my computer, but I'm certainly not in a rush. Thank you, though, for the reassurance!

 

[Monster's Mom]

I'm sorry he's not feeling 100%
I understand why you feel he needs an increase. He just doesn't seem to want to stay in lower numbers. I hope you can get him down soon and good luck with Vet Monday!

 

[Tyleete]

He definitely seems like he wants the increase.
Hope you can get him to stay in the better numbers soon

 

[Staci & Ivy]

View attachment 75925
Morning snuggles.

... I am concerned that he may be experiencing increased oral pain, based in part on discussion here last night. I watched him carefully this morning, and he seemed to begin moving very stiffly after eating his breakfast (and wasn't compelled to return for a mouthful of dry food when I set it out, after I was satisfied that he'd consumed the medicated portion of his wet food). He didn't hide this time, and was cooperative for his shot, but ... I found the change in movement striking. He had been all fluid grace when I first got up to start preparing his meal.

(If he is in increased oral pain, it's not stopping him from eating. He ate hungrily this morning, and even moreso last night, to the point that I had to put out a little extra before bed to make sure he'd have overnight snacks available, which isn't usually necessary. But it worries me for its own sake. This will be one of the things I focus on with the vet on Monday.)

What a sweet picture of sweet Gen. He’s so photogenic
I’m glad you’re out today to get a little break. Enjoy being on vacation

I hope you get some answers on dosing Allie. You both are doing great. You’re thoughtfully going through the process and evaluating all of the information and assessing what he needs.

Good luck at the vet on Monday. I hope they have more good ideas on what will help him feel better

Sending you both lots of hugs and wishing you a calm night

 

[Wendy&Neko]

Some things to ponder. First, Gen seems to take about six cycles between greens, or at least that is what he did last time. Today is cycle 4. I might wait to see if he sees any action tomorrow during the day before making a decision on dose.

Twice now, Gen has hit below 90 on that Libre. Normally that would mean reduce with SLGS. But without a backup test with a BG meter, it's hard to say whether that was really below 90. I know that's what you are dealing with. Maybe looking around at some of the other caregivers with Libre only situations using SLGS and see if they've tweaked their reduction point. Libre is usually lower than BG meter, but we've also seen some cases where it is not. Keep in mind, safety first.

Some brief nice numbers followed by high is not uncommon with cats with insulin resistance, which can be caused by dental inflammation or infection. I hope you have a good vetty appointment next week.

 

[Albert & Xander]

I don't have any helpful advice to offer but wanted to drop in and say I was impressed by the additional nadir chart!
As a data analyst, I can't help but create extra spreadsheets in addition to the standard one to try to look for trends

Have a great weekend Gen and Allie

 

[Christie & Maverick]

I’ll add perhaps a few more things to consider. In the early December dosing that you mentioned, you had jumped up from 0.75u to 1.25u so at that time, when Gen dropped to greens after 8 cycles, the reduction to 1u would have made sense. I’ve shared some of my thoughts previously on bouncing and on some of the challenges with Libre, but do appreciate that it allows caregivers who can’t manually test some good visibility on BG that they wouldn’t have, so even just for that reason I like it. I will say, since you mentioned that Gen is a grazer, is that you are home with him for the holidays, you may want to see about experimenting with feedings early in the cycle, at +1, +2, +3 to help slow BG drops a little. Steep drops and/or hitting numbers the cat isn’t used to will lead to bouncing. So take for example the cycle that started the last bounce, Dec. 18th. Steep drop into +2, pink preshot to blues. Because you have the Libre, you can see he came down to yellow already at +1, so if you see something similar, feed a couple teaspoons of his usual LC. Same again at +2 and +3. It can help to flatten out the curve, and sometimes with bouncy kitties, it’s a good strategy you may want to try. More info here 8/10 TASHIE pmps=HIGH! +Questions***

I agree that at some point, in the absence of handheld checks at lower numbers, one does need to decide what number on the Libre they want to use in order to take a reducie. I like Wendy’s suggestion to compare what others with Libre testing generally see. The good news is that there are many more Libre users these days, some short term, some long term.

There can often be variables which influence BG, including how the insulin is absorbed/used, carb sensitivity of the cats, fluctuations in carb content in the food, when the food is fed, and possible infection among other things.

I’m glad you are going to see the vet, although it’s good to hear Gen seems to be feeling ok on some fronts at least, like interest in eating. I’d be more concerned if he’s not eating, since that combined with infection/inflammation can increase risks for ketones. Still worth mentioning to vet, and whether they can run a urinalysis. And, if the vet is inclined to run some blood work, you may want to ask about getting a pancreatitis test. If your vet has a Catalyst One In-House Analyzer, they can add it, and it gives you a number, not just a yes/no like the old SNAP fPL. Vets used to have to send the blood out for a spec fPL to get a diagnosis of pancreatitis.

I feel like I’m missing something else, but I suppose I’ve given you enough food for thought for the time being

 

[Lauren & Esse]

I like Wendy’s suggestion to compare what others with Libre testing generally see.

I have been thinking about making a page in my spreadsheet to cleanly compare the meter numbers to what the Libre was showing at the same times, this might be the motivation I need to do it. I'm not very handy with analyzing data like Allie and Albert but maybe just getting the data would be a good starting point.

Edit: I added a tab--I was only able to export Contour data from Sept-now, will have to play around with the meter to see if I can manually locate older data.