? 14 Aug | Girlie | AMPS 709; +2=616: Dose advice?

[Girlie's mom]

Condo: http://www.felinediabetes.com/FDMB/...-4-124-5-196-bouncy-baby.182114/#post-2019021

Hi all,
I'm trying to figure out why Girlie is still hanging out in the high numbers, even though it looked like she broke her bounce on the 12th, albeit with a 320 point dive at +2; she got as low as 122 on 12 Aug but then was back to HI by PMPS. We had the hospital incident (straining and vomiting) on 9 August.

On 13 Aug I gave her LC 9 food; I was wondering if that higher LC number might help slow down a dramatic dive at the start that I saw on 12 Aug. In the evening I gave her LC 1 food.

14 Aug: This morning I gave her the same LC8 food as I have to leave for a few hours for physio.

I'm just wondering why she's holding on to these high numbers. It seemed that she broke the last bounce within 3 cycles. Did she dive too low and too quickly on 12 August? Is that what could be causing this? Or could it be food related?

Girlie, Girlie, you're doing my head in!

Still no ketones in Urine, thank goodness... But clearly having constipation issues again, despite pumpkin and miralax and cisapride. Sigh...

 

[Cherish Gallagher]

Our non diabetic has megacolon and a motility disorder. He had constipation issues for 6 months. The only thing we've found that works is a compounded mix of cisapride and lactulose. Something about yer combo works well. Also we use infant subpositories as needed. I know a lot of people swear my miralax but our vet said not to use it.

 

[Mandy & Rex (GA)]

Girlie is bouncing from the steep dive that day.

 

[Sienne and Gabby (GA)]

Darrah --

If you're following TR, you are holding the dose for too long of a period. Once you're past the first 5 - 7 days on Lantus, if numbers are above a normal BG range, you increase the dose by 0.25 units (or 0.5u if the nadirs are generally above 300) every 3 days unless your kitty is consistently in normal numbers.

Since it looks like Girlie's nadirs are falling below 200 except when bouncing, I'd consider increasing the dose to 0.75u. Unless numbers drop below 50 (on a human meter), you will want to increase the dose after 3 days/6 cycles.

You may want to review the TR sticky so you know what the exceptions are.

 

[Girlie's mom]

Darrah --

If you're following TR, you are holding the dose for too long of a period. Once you're past the first 5 - 7 days on Lantus, if numbers are above a normal BG range, you increase the dose by 0.25 units (or 0.5u if the nadirs are generally above 300) every 3 days unless your kitty is consistently in normal numbers.

Since it looks like Girlie's nadirs are falling below 200 except when bouncing, I'd consider increasing the dose to 0.75u. Unless numbers drop below 50 (on a human meter), you will want to increase the dose after 3 days/6 cycles.

You may want to review the TR sticky so you know what the exceptions are.

Does this apply even if the high numbers are a result of a medical incident (diagnosed with Colitis; straining and vomiting for hours), no insulin, and two visits to the emergency room on 9 Aug (5 days ag0)? She broke those high numbers with a spectacular dive on 12 Aug, so could she be bouncing up again because of that?

 

[Girlie's mom]

@Wendy&Neko , do you also think I should increase her dose? I could do an increase tonight to 0.75 or 1 U, but I have to dash out in the next two days in the afternoons for dr/work appointments; that should be after any dives, I'd hope. Or I could wait a few more cycles to see if this bounce up is due to her dramatic dive the other day. I'm just not sure as this is all new to me... if increase, should I do 0.75 or 1 U?

 

[Wendy&Neko]

When you want dose advice, it's best to put "dose advice?" in your subject heading to get more eyes. Sienne was one I went to for dose advice when I was new. As she said, you have seen blue nadirs, so a 0.25 unincrease is appropriate. As long as you hav six cycles in a row on a dose, you can evaluate it. I presume you shot 0.5 u on the night of the 12th? It is currently blank. Anyway, this dose isn't getting you where you want to be.

 

[Mandy & Rex (GA)]

Good luck with the dosecrease!

 

[Girlie's mom]

Good luck with the dosecrease!

Thanks for the hug!!

 

[Girlie's mom]

When you want dose advice, it's best to put "dose advice?" in your subject heading to get more eyes. Sienne was one I went to for dose advice when I was new. As she said, you have seen blue nadirs, so a 0.25 unincrease is appropriate. As long as you hav six cycles in a row on a dose, you can evaluate it. I presume you shot 0.5 u on the night of the 12th? It is currently blank. Anyway, this dose isn't getting you where you want to be.

Thanks so much, Wendy and @Sienne and Gabby (GA) ! I guess I assumed that since I started TR on 1 August that I should hold that dose for a week, but I guess that only applies to those new to insulin? that would have taken her through 7 August. But then on day 8, her nadir was 106, so under 200, so doesn't that mean to hold the dose again until increasing?

Just a note: I'm using AlphaTRAK2 - not a human meter.

I guess I'm unclear on how to distinguish, still, between a) a nadir and b) a reaction to a deep dive (like the 76 nadir on 4 Aug or the nadir on 12 Aug of 122 but a dive of 320 points) and thus how to determine that the dose is not working and she needs an increase, especially as her lowest points have all been under 200: shouldn't I hold the dose if her nadirs are under 200? She had her best day on 8 Aug (day 8), but her nadir was 106, so under 200. From the TR sticky, I thought that

"Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.

• if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing."

But then the following day she was really ill, and then 3 days later she again had a nadir of 122 - or just a deep dive bounce?

When a cat has been ill and that has thrown the numbers off, would you still increase?

I'm officially confused! Also, add to that the fact that numbers do my head in, so having a diabetic cat is not ideal for me...

On day 4 (4 Aug) she had a nadir of 76 but an AMPS of 545, so a huge dive: should that have qualified her for a dose decrease, or was she just bouncing madly?
Day 5 - 7 (5-7 Aug): She bounced up to black and red - I thought that was because of the steep drop on 4 Aug?
Day 8 (8 Aug): broke that bounce and had a nadir of 106 @+3 and highest was PMPS at 491
Day 9 (9 Aug): Emergency room drama with colitis: straining and vomiting for hours; no AM shot
Day 10-11: I thought she was bouncing up from being ill on 9 Aug?
Day 12 (12 Aug): Big dive again from AMPS of 556 to +2 of 235; nadir 122 @+3; HI at PMPS and PMPS +2
Day 13: back to black: nadir of 376 @+6; AMPS 742
Today (Day 14): AMPS 709; +5=346

 

[Wendy&Neko]

You hold the dose long enough to build the depot, usually 3 days, and see what a dose can do. By which I mean, what are the nadirs and how low does a given dose take Girlie. That nadir can be any point in the cycle and is the low point of that cycle. Ignore the bounce cycles when figuring out what a dose can do.

Depending on the nature of the illness, you may or may not delay an increase. illnesses could have inflammation, infection that raise their blood sugar. If I thought something was very short lasting, I might hold off an increase to see if she could bring down her nadirs. If longer term, they need more juice, until they tell you they don't, by earning a reduction.

 

[Girlie's mom]

You hold the dose long enough to build the depot, usually 3 days, and see what a dose can do. By which I mean, what are the nadirs and how low does a given dose take Girlie. That nadir can be any point in the cycle and is the low point of that cycle. Ignore the bounce cycles when figuring out what a dose can do.

Depending on the nature of the illness, you may or may not delay an increase. illnesses could have inflammation, infection that raise their blood sugar. If I thought something was very short lasting, I might hold off an increase to see if she could bring down her nadirs. If longer term, they need more juice, until they tell you they don't, by earning a reduction.

I guess this is where my confusion comes in: isn't she in a bounce cycle now in reaction to the deep dive on 12 August?

Does that just mean that I ignore that she's bouncing in black for the past two days and increase her dose anyway tonight because on 12 Aug her nadir was 122 but her PMPS was so high?

She was high for 3 days (5 - 7 August) but then broke that bounce beautifully on 8 August before getting sick on 9 August. I guess I don't completely understand why I should increase today when she's (I think?) in a bounce from a reaction to the deep dive on 12 August. If I shouldn't wait for her bounce to break, that's fine! I'm just confused, I guess... I didn't realize that you could increase doses when you were in the middle of a bounce.

If I increase and then she does a dramatic deep dive again, as seems her particular joy in life right now, do I just ignore that unless it dips below 68 (for AlphaTRAK), in which case she gets a reduction in dose again?

 

[Girlie's mom]

Just a spreadsheet note: I put all my data in the World spreadsheet. It's pretty quirky about whether it wants to translate that data over automatically to the US spreadsheet. Any suggestions on that? I just had to manually put in the +4 number on the US sheet as I noticed it hadn't gone over automatically. Is this a common problem?

 

[Sienne and Gabby (GA)]

I'm tagging @Marje and Gracie to see if she can answer your spreadsheet question.

I agree with Wendy's point re. a cat's numbers and illness. It can be a delicate balance. We see any number of kitties who will have a UTI or other illness and their numbers are high. Once an antibiotic kicks in or the illness clears, the numbers can drop and can drop quickly. However, any form of infection or inflammation can contribute to the development of ketones, especially if numbers are very high and/or your cat is prone to developing ketones or recently had an episode of DKA. The balancing act comes in when you need to increase the dose because numbers are high but take into account where the nadir may actually be. In Girlie's case, the nadirs are mostly in the blues. Unless there is a huge amount of momentum behind a bounce breaking, it's unlikely that the numbers will drop dramatically low. (That said, never assume your kitty won't throw a wrench into the works.)

 

[Marvin's Mom - Nat]

Just a spreadsheet note: I put all my data in the World spreadsheet. It's pretty quirky about whether it wants to translate that data over automatically to the US spreadsheet. Any suggestions on that? I just had to manually put in the +4 number on the US sheet as I noticed it hadn't gone over automatically. Is this a common problem?

I have had similar problems, especially when adding rows or text in the global, it throws off the formulas on the US tab. I know how to fix it, however it a case by case basis. correcting the formula....