12/24 Zeke PMBG +9 - shoot thru the bounce?

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MrZ

MrZ

Member Since 2013
Good morning LL,

Sending good appy and great BG vines to all.

Well we decided to up Zeke's dose last night. It did the trick. Zeke was at 109 at AMPS. At +1 he's at 61. It appears that perhaps Zeke's BG was dropping. Now I'll need to work a little to get him from dropping too low. Hopefully the 2 tsps. of 20% gravy will get him up. Will be testing in 30, and throughout the morning.

Zeke's yesterday
 
Re: 12/24 Zeke AMPS 109; +1 = 61; +2 = 36

Zeke, where are you going, dude?
How long ago was that 36, Laura?
 
Re: 12/24 Zeke AMPS 109; +1 = 61; +2 = 36

Well, this is my fault. I thought about testing again at shot time to make sure he wasn't dropping but then I thought, "Even if he's dropping he's not that low and he typically rises after his PS meal." Big mistake. I had to rub 2 drops maple syrup on his gums. Also gave him 20% gravy 1t and 13% food 1/2T. Will test in 15.
 
Re: 12/24 Zeke AMPS 109; +1 = 61; +2 = 36

OK, I'll watch for it.
 
Re: 12/24 Zeke AMPS 109; +1 = 61; +2 = 36, 45

For future reference, I really think you need to put your hands in mittens and then sit on your hands when your trigger finger gets itchy. When you are evaluating the effectiveness of a dose, it's important to look at the nadirs you've been getting. Zeke was dropping to 50 on the 1.5u dose. I would have held the dose and not increased. What you're seeing is the result of the increase. Tonight, you need to go back to the 1.5u dose.
 
Re: 12/24 Zeke AMPS 109; +1 = 61; +2 = 36, 45

I just fed him 12% 1t. There were a few times in the last couple of days that Zeke was not wanting to eat when I needed him to. As a result, I went and bought a nice variety of different foods. I am so glad I did. He loves Merrick's Thanksgiving Day Dinner - not having any trouble getting him to eat it. Was wondering, is it best to keep his meals to grain-free always, or at low-BG times does anything go (i.e., ok if rice, wheat or potato)?

Since he's up to 45 and he also ate, I'm planning on waiting 45 minutes to test again. OK?

Well, even though he probably hit the 36 because I (most likely) shot a dropping number, I do need to reduce and go back to 1.5u tonight? I know the answer is yes but I can't help but ask. Safety first.

Maybe the 243 was just a bounce even though we thought he'd "snapped". Do you think?
 
Re: 12/24 Zeke AMPS 109; +1 = 61; +2 = 36, 45

Laura

Yes, you must reduce the dose and I would check every 30 mins after feeding until he's up above 70 because he has a long time to nadir.
 
Re: 12/24 Zeke AMPS 109; +1 = 61; +2 = 36, 45

On the reduction....yes. A number under 40 pretty much forces a reduction. Even the most experienced people do this :o when they see under 40.

If you can find a grain free food that is MC or HC without grains, that's fine, but if the purpose is just to use it to bump up low numbers, I don't think ingredients are a great concern.
Grain-free, is preferred, I would think, overall. Usually lower carb, plus the source of proteins would be meat rather than plant.
 
Re: 12/24 Zeke AMPS 109; +1 = 61; +2 = 36, 45

MrZ said:
Maybe the 243 was just a bounce even though we thought he'd "snapped". Do you think?
Click to expand...

What are your thoughts on the 243? If bounce then I guess that means Zeke didn't snap, right?

Do you think that since his AMPS was lower than his +5.25 from last night that he was likely clearly the bounce from the 243?

BTW - I plan on holding the 1.5u awhile - No me gusta the 30s.
 
Re: 12/24 Zeke AMPS 109;+1=61;+2=36/45;+3=35/44

The 243 confused me, Laura. Yes, might be a bounce, just hard to see what led to it. Zeke had been in nice green numbers for days, and even the 50s didn't cause bouncing. Then the AM cycle from yesterday just looked "out of place. So it seemed logical that maybe the dose was too low, leading to an increase last night.

This isn't very helpful, but when I see a cycle like that, all I can do is scratch my head, shrug my shoulders, and think "beats the heck out of me, it just was what it was" :-)

Maybe his pancreas had been helping, and yesterday it just decided to take a day off? For whatever reason, today he decided to respond to the dose increase immediately, and a little bit too well. His numbers had been trending down since last night's shot, which looks like "bounce clearing" to me. So you combine a bounce clearing with a possible falling number at AMPS, and it equals "active cycle" like you are seeing this morning.
 
Re: 12/24 Zeke AMPS 109;+1=61;+2=36/45;+3=35/44

As far as the "snapping"....
I can't help there. When I saw that mentioned yesterday, it was a new term to me. Unless it refers to what I've seen as the "breakthrough dose".
 
Re: 12/24 Zeke AMPS 109;+1=61;+2=36/45;+3=35/44

Yes, I believe it does mean breakthrough dose. I went back and looked at what Marje wrote. She wrote:

When the liver becomes accustomed to normal numbers and kitty quits bouncing, we say they have "snapped". They start spending more and more time in normal numbers and the amount of insulin needle decreases....and sometimes quickly.

So, the fact that he bounced to 243 (what else could it be but a bounce), means he has not yet snapped. I guess I'll have to wait and see what happens in the coming cycles. If ever he had a reason to bounce, it would be today's struggle to keep him from falling below 35 and trying to get him above 50.

I had to give him a lot of gravy and syrup today and I still couldn't get him above 50. Would a pill pocket have been a better option? I've never tried them.

I once saw a post by someone who said their roommate gave their sugar baby too much Karo and the Kitty had to be detoxed for days. I know you have to do what you need to to keep your kitty safe but how much maple syrup is too much, as far as "long-term" impact to his BGs?
 
Re: 12/24 Zeke AMPS 109;+1=61;+2=36/45;+3=35/44; +4=48

So, the fact that he bounced to 243 (what else could it be but a bounce), means he has not yet snapped. I guess I'll have to wait and see what happens in the coming cycles. If ever he had a reason to bounce, it would be today's struggle to keep him from falling below 35 and trying to get him above 50.
Click to expand...

Or it just means that Zeke had a wonky cycle. What I always keep in mind was something that Dr. Lisa posted on PZI almost two years ago. It helps me to ignore "wonky". I can find the link later, but basically -

It isn't all just about how much insulin or food you get into his body. Or carbs. Those are just the only two things that you have direct control over. What Zeke does with that food and insulin is up to Zeke. What his system does and how efficiently it does it is out of your control. All you can do is react, and make adjustments accordingly. So when I see a wonky cycle, I recognize it as such. Then I step back and look at the "big picture"and admit that the "little picture" defies explanation. All you can do is manage it hour by hour, get past it, and then say "whew, that was fun".
 
Re: 12/24 Zeke AMPS 109;+1=61;+2=36/45;+3=35/44; +4=48

I once saw a post by someone who said their roommate gave their sugar baby too much Karo and the Kitty had to be detoxed for days. I know you have to do what you need to to keep your kitty safe but how much maple syrup is too much, as far as "long-term" impact to his BGs?
Click to expand...
I'm not familiar with the post in question, but would have to think "too much" would be measured in syringes full, not just in a few drops mixed into food or rubbed on their gums.
 
Re: 12/24 Zeke AMPS 109;+1=61;+2=36/45;+3=35/44; +4=48

Laura

I didn't and don't want you to get fixated on whether Zeke has actually snapped or changed. If he does, he does but it's better to just focus on what he needs in terms of insulin and how he's doing clinically. I apologize for mentioning it because I dont want you to think he might not ever bounce again or throw a wonky number in there like he did yesterday.

Yes....the yellow number could have been a bounce or it could have been a lack of absorption or it could have been the barometric pressure or it could have been him being a cat. I should have suggested you hold the 1.5u dose and br patient. So I apologize to you for not doing that.

I do understand the angst when you start getting all those greens and the dose is coming down and then you see a yellow. I have also dosed aggressively to keep the momentum going because I test a lot, too. You recognized the one thing I would have told you...if you are going to be aggressive, you must know if you are shooting dropping numbers or not and be cautious. I'm glad you stayed on too of the testing. I have occasionally shot a higher dose one cycle to get the numbers back down ...it worked a little too well for Zeke, didn't it? We should have considered just adding a bit of fat to fine tune.

I think it is best to use this as a learning tool. Zeke might do this again and next time, we will all be patient.
 
Re: 12/24 Zeke AMPS 109;+1=61;+2=36/45;+3=35/44; +4=48

i think another thing to keep in mind is that lantus/lev dosing is primarily based upon nadirs, not the high numbers.

good job handling the low numbers, laura!
 
Re: 12/24 Zeke AMPS 109;+1=61;+2=36/45;+3=35/44; +4=48

The other thing to keep in mind if you get a number that seems out of place is that it may be a bad test or a bad strip. You can always re-test.
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+3=35/44;+4=48;+5.5=47

Thank you all for you comments. Yes, this has been a huge learning experience.

I do want to stress one thing however: I take full responsibility for the dosecrease. If I had stuck with the 1.5u and he'd have spiked and stayed in yellows or even worse pinks, I would have been very upset with myself for "screwing" up Zeke's really great run. I decided to be aggressive because I knew I would be home and if ever there was time to be so, I believed it was now. This is my personality and despite your motto of putting on the patience pants, this was just one of those times that I could not. I do however recognize, as Marje stressed, I have to be extra cautious if I am going to dose aggressively. I did absolutely (immediately) recognize that I messed up by not confirming that he was not dropping at shot time - the biggest no-no one can make. I'm no expert but I would guess what I'm dealing with is the consequence of shooting a dropping number and not the dosecrease. In either case, lesson learned and reinforced.

My immediate concern is that I've not been able to get his BG up. Just gave him more gravy and I think he's just about reached his fill. I'm concern I'm gonna start to have difficulty getting him to eat anymore. What's my best option now? What should I do? What about a pill pocket? He doesn't like them but if I break off a piece and just toss it down his throat is this something you think I should consider?
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+3=35/44;+4=48;+6.25=41

Pill pockets have carbs, not sure how much, but it's a very small serving. I think a better option would be syrup or a combination of the too. Like one dipped in syrup? A full belly is not great at this point. Liquids will get more carbs in less volume.
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+3=35/44;+4=48;+6.25=41

I'm no expert but I would guess what I'm dealing with is the consequence of shooting a dropping number and not the dosecrease. In either case, lesson learned and reinforced.
Click to expand...
Likely a combination of the two, if it was last night's increase that led to the dropping number?
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+3=35/44;+4=48;+6.25=41

I know we're still hours away but I don't know if anyone is going to be on the board tonight so I thought I'd better ask now. OK, so now I'm wondering if I shouldn't scale back even more, at least for tonight? Since I'm having such a hard time getting him up, I'm wondering if I should actually shoot a 1.25u tonight to drain the depot. If today's struggle was due to shooting a dropping number then I would think it doesn't make sense to reduce more than the .25u (and shoot 1.5u). However, if yesterday's highs was just wonkiness, then it would seem shooting 1.25u might be the way to go. How on earth am I to know?

Your thoughts?
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+3=35/44;+4=48;+6.25=41

I've given Gracie small pieces of chicken pill pockets and it didn't raise her BG. But ECID.

I would rub some karo on his gums. He needs to be out of these low numbers. You don't have to OD him on karo but I'd do it and try to get the numbers up; they may come back down but maybe by the time they do, he'll eat.

And we can see where he goes by PMPS but consider this: even if you reduce the dose to 1.25u tonight, it's still enough of a dose that you might not see any real change until subsequent cycles. If he's still lower by PMPS, I might actually think about skipping a cycle and see where he is tomorrow. I know you won't like that thought BUT just keep it in the back of your mind if he's still running lower by PMPS.
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+3=35/44;+4=48;+6.25=41

Marje - I actually am very much thinking about skipping the dose tonight. All those carbs today and his BG just would not go up. He's at 57 at +8.5.

If I skip tonight then hopefully it will drain the depot enough that tomorrow will be a lot more manageable. We'll wait and see where he's at come shot time.
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+3=35/44;+4=48;+6.25=41

Good. I'm glad we are on the same page. Sometimes you just have to skip....it's only one cycle.
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+3=35/44;+4=48;+6.25=41

At +9.5 he's slightly down at 51. I wasn't sure if I should give him the MC or HC instead. I fed him his normal LC (food sort of). He had 1/2T 4% (usually 1T) and 5% 1t (I don't normally give him 5%) but he didn't quite finish it. He's now into his 2 hour fasting preshot period. If he continues to drop, I'll have to give him MC or HC and pass on tonight's shot. Ever seen anything like this? Did I OD him?
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+6.25=41;+7=60;+9.5= 51

you just have to keep up carbing him and retesting every half hour or so, regardless of how close to the next shot time it is. it's more important to focus on the moment. i suspect skipping the next shot is a good move as well.

i don't know that you OD'd him, but i think you underestimated the value of following the protocol. i'm not trying to make you feel guilty - we all wish we could change something we've done with our cats. the important thing is always to look at what's happened when you made choice A and if you are confronted with a similar situation again, remember how he responded the last time and use that to make the next decision.

the protocol is already aggressive, you don't have to be more aggressive than its guidelines. a hypo on Lantus can last a long time. no one likes high numbers, but if you can see them in context of the low nadirs, it helps understand the whole thing better. Zeke's body is in charge of this dance.

i'd use karo on the gums if you can't get him to eat anymore.
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+6.25=41;+7=60;+9.5= 51

And if you skip, Laura (which I think is a good idea), please keep testing him until he's safely up. You don't have to test, necessarily, every 30 minutes or an hour but you'll know how often to test based on his numbers. Even though you skip, that depot will still be working some so it's important to be sure he's on the way up on his own before you quit testing.
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+7=60;+11=59

Merry Christmas Eve to you too Marje.

Actually, after today's morning cycle, I'm kinda hesitant to shoot ever again. I hope we don't have another day like today with him going below 50 and not wanting to come up easily.

He was under 50 (clinically hypo, right?) for over 4.5 hours. Could there be any health ramifications from that (like in brain damage)?
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+7=60;+11=59;+13=78

Not "clinically hypo", I don't think Laura. "Clinical" would be (again, unless I'm mistaken) if he displayed hypoglycemic symptoms like dazed looking eyes, loss of balance....physical evidence that his low numbers were having a visible effect. (see moderate symptoms below)

I don't think long term consequences are an issue with this today. Like brain damage. If he'd had some kind of seizure, or just flopped down on the floor and would not respond to you, then possible there would be some short or long term effects. He was definitely low enough, lower than you wanted him especially that early in the cycle. And the carbs you gave him kept him from dropping further.

One thing I've seen is that some kitties are extra-sensitive to insulin right after a long run of low numbers that don't respond well to efforts to "carb them up". I believe that skipping tonight was the right choice and glad to see that you did.

This is from the "How to treat hypos" sticky

SYMPTOMS
Some cats may have NO symptoms whatsoever, but here are the most common ones:

MILD HYPOGLYCEMIA
Sudden ravenous hunger
Shivering
Weak or lethargic

MODERATE HYPOGLYCEMIA
Disorientation
Trouble with vision... bumps into furniture
Poor coordination, such as staggering, walking in circles or acting drunk
Changes in head or neck movements
Restlessness
Urgent meowing
Behavioral changes, such as aggressiveness

SEVERE HYPOGLYCEMIA
Convulsions or seizures
Unconsciousness
Click to expand...

I think that some people have seen mild symptoms on occasion, but progressing to moderate is a lot less common. As for severe, I can only recall reading about those a couple of times since I've been around. In both of those cases, the caregivers came home to that situation, they weren't there monitoring the cat to see any of the initial symptoms.

He is definitely done with 1.75u right now. I am not sure what the next step is, or if you've decided on 1.5 or 1.25 when he gets his next shot.
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+7=60;+11=59;+13=78

Carl is right......he did not have a clinical hypo.

None of us like kitties to be in the 30s and the main issue with them being in the 40s is there is no cushion to the 30s. Please do not be hard on yourself. There's not very many of us who haven't experienced a day like today; no one likes them and they need to be taken seriously but when the depot is full, it can happen.
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+7=60;+11=59;+13=78

i'm thinking you're thinking hypo because i mentioned a Lantus hypo having the potential to be a long event. i didn't mean that HE had a hypo. I"m sorry for confusing you!!

There's a difference between low numbers, which you definitely were dealing with, and a hypoglycemic event. Zeke will be fine. There's no harm from this - early on i tested punkin and got a low 30's. posted and someone walked me through how to pull him up. you did fine in how you handled everything today. don't worry at all about Zeke.
 
Re: 12/24 Zeke PMBG +9 =348. Shoot thru Bounce?

Should I shoot through the bounce and give 1.75.
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+7=60;+11=59;+13=78

I would not. This is more due to 24 hours without insulin, I think. I would go with 1.5. Take the reduction.

Merry Christmas, Laura :-D
 
Re: 12/24 Zeke AMPS 109;+2=36/45;+7=60;+11=59;+13=78

It's been just 1 cycle no insulin. Sorry, I guess I should have shown PMBG+9. I guess because he went so low, I should not shoot thru the bounce. I figured since the depot was already drained some last night it would be ok. I just wish I could because he's so high. I will put on my patience straitjacket and shoot the 1.5.
 
When I said 24 hours, I meant he hasn't had a shot since yesterday's AMPS, right?

Carl
 
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