2/5 Niko | AMPS 140, +4 266, +7 230

[Niko's Mom]

Previous post: https://felinediabetes.com/FDMB/thr...-2-185-4-166-6-160-9-211.298074/#post-3243351

Niko had a nice, slow surf yesterday and a lovely AMPS this morning. Expecting a bounce later today but happy he went down gradually yesterday.

Question for you folks -- Niko seems to have this pattern with his new doses:
Days 1-4: bouncing (big highs, big lows)
Days 4-5: Stagnating yellows
Days 6-7: Stagnating yellows, pinks

Is this 'glucose toxicity' or 'insulin resistance'? Is his pancreas just fighting back because it's not used to the amount of insulin?

Do we just need to keep increasing the dose until we find something that brings him down and keeps him down throughout the entire 7 day hold?

He is off kibble now so I am considering switching to TR instead of SLGS.

When do we start considering things like IAA and acromegaly testing?

Many thanks!

 

[Angela & Cleo]

Hi Ana, Niko's SS looks like a newly diagnosed diabetic kitty SS to me. He's only been on insulin for a month and has already shown some mid blues . I haven't read your prior posts (yet). Was Niko ever DKA or just showing ketones? Do you have the ketostix to test urine or a blood ketone meter?

When following SLGS you hold the dose for at least 7 days/14 cycles unless you get a BG under 90. Since you removed dry food, are you considering a switch to TR? TR would have you increase every 3-5days if the numbers warranted it and get you to a good dose a little faster.

 

[Niko's Mom]

Hi Ana, Niko's SS looks like a newly diagnosed diabetic kitty SS to me. He's only been on insulin for a month and has already shown some mid blues . I haven't read your prior posts (yet). Was Niko ever DKA or just showing ketones? Do you have the ketostix to test urine or a blood ketone meter?

When following SLGS you hold the dose for at least 7 days/14 cycles unless you get a BG under 90. Since you removed dry food, are you considering a switch to TR? TR would have you increase every 3-5days if the numbers warranted it and get you to a good dose a little faster.

Hi Angela! Yes, he seems sensitive to the first few days of a dose (where we get sick blues) then bounces back haha. He was never in DKA... sort of? He is a weird guy. He was behaving normally with no infection with a blood ketone level of 6.9 when we took him to the ER vet (this is because we did a diet change first, and I was monitoring his ketones via urine because I could smell it on him).

Anyway, he had nothing remarkable about his bloodwork, officially he was in 'metabolic acidosis' but had a normal appetite, behavior, etc. We started him on Lantus that day. He had ketones up until we bumped him to 1.00 units. I monitor him every day via urine. I also have a blood ketone monitor now.

I am considering starting TR now that we have more data on his numbers. I did have a question though. His nadirs tend to be all over the place (sometimes it's a late nadir +11 or +12, sometimes its +5, sometimes +8...), and he bounces a lot. With TR, how do you know if you are having a 'bounce' vs. a 'nadir' and whether or not you have to increase?

Thanks so much in advance.

 

[Angela & Cleo]

Hi Angela! Yes, he seems sensitive to the first few days of a dose (where we get sick blues) then bounces back haha. He was never in DKA... sort of? He is a weird guy. He was behaving normally with no infection with a blood ketone level of 6.9 when we took him to the ER vet (this is because we did a diet change first, and I was monitoring his ketones via urine because I could smell it on him).

Anyway, he had nothing remarkable about his bloodwork, officially he was in 'metabolic acidosis' but had a normal appetite, behavior, etc. We started him on Lantus that day. He had ketones up until we bumped him to 1.00 units. I monitor him every day via urine. I also have a blood ketone monitor now.

I am considering starting TR now that we have more data on his numbers. I did have a question though. His nadirs tend to be all over the place (sometimes it's a late nadir +11 or +12, sometimes its +5, sometimes +8...), and he bounces a lot. With TR, how do you know if you are having a 'bounce' vs. a 'nadir' and whether or not you have to increase?

Thanks so much in advance.

I have to run out for a few but will come back and post LOTS of links (lol) that explain all this.

 

[Angela & Cleo]

I monitor him every day via urine. I also have a blood ketone monitor now.

Perfect! Ketones to DKA can develop quickly and can be scary and scary expensive . Best to stay on top of this.

His nadirs tend to be all over the place

Very typical of a newly diagnosed diabetic

(sometimes it's a late nadir +11 or +12, sometimes its +5, sometimes +8...)

You're not imagining things...Nadirs do tend to move around a bit.

With TR, how do you know if you are having a 'bounce' vs. a 'nadir' and whether or not you have to increase?

We look at patterns over several days/cycles for trends. We look at how low the dose is taking the kitty over a period of 3-5 days (6-10 cycles). In that time frame, how low did the dose take the kitty? Lets say he gives a nadir of 75. That's great, lets see if he can do it again. You would hold the dose giving time for a bounce to clear (usually 2-3 days), can he get to that same nadir? If so, hold a little longer. If higher, and above the 50-80 range, say 100, then increase. If the dose isn't getting you to good nadirs there's no reason to hold it longer than 5 days. If the dose is working, then hold!

You can always post with a question mark in your thread title and ask for advice.
Here is one of my FAVORITE info stickies which I read all the time and has calmed my nerves many many many times.

Should you choose to switch to TR, it would allow for increases more often, but SAFELY to get Niko to a dose which is giving him more blues and greens. Greens and being Tightly Regulated is the goal. You'll have to get comfortable with shooting lower and eventually lower preshots, but you'll get there.

 

[Niko's Mom]

Perfect! Ketones to DKA can develop quickly and can be scary and scary expensive . Best to stay on top of this.


Very typical of a newly diagnosed diabetic


You're not imagining things...Nadirs do tend to move around a bit.


We look at patterns over several days/cycles for trends. We look at how low the dose is taking the kitty over a period of 3-5 days (6-10 cycles). In that time frame, how low did the dose take the kitty? Lets say he gives a nadir of 75. That's great, lets see if he can do it again. You would hold the dose giving time for a bounce to clear (usually 2-3 days), can he get to that same nadir? If so, hold a little longer. If higher, and above the 50-80 range, say 100, then increase. If the dose isn't getting you to good nadirs there's no reason to hold it longer than 5 days. If the dose is working, then hold!

You can always post with a question mark in your thread title and ask for advice.
Here is one of my FAVORITE info stickies which I read all the time and has calmed my nerves many many many times.

Should you choose to switch to TR, it would allow for increases more often, but SAFELY to get Niko to a dose which is giving him more blues and greens. Greens and being Tightly Regulated is the goal. You'll have to get comfortable with shooting lower and eventually lower preshots, but you'll get there.

Thank you SO SO much for this. That's the one thing I was worried about with TR - he's such a bouncer, I wasn't sure if one 'pink' at his usual nadir would offset the other blue he would have the next day, and how we'd calculate that.

Basically, since we just did a dose increase to 1.50 -- yesterday his nadir was around 160, today we are calculating but it looks like he is rising (currently at 266 for +4), and I anticipate a high PMPS. if in the next two-three days he continuously sits somewhere around a 160-280 (or higher) for his nadir, we increase to 1.75, correct? but if he somehow has a nadir of 100, do we wait another cycle or just increase anyway? then do the same thing again?

I will take a look at that sitcky. I think we are comfortable with shooting low (he never seems to drop dramatically, just rises dramatically lol), but I know I'll get that anxious feeling when we get our first green PS....

 

[Angela & Cleo]

Basically, since we just did a dose increase to 1.50 -- yesterday his nadir was around 160, today we are calculating but it looks like he is rising (currently at 266 for +4), and I anticipate a high PMPS.

I see that too. Enjoy the time off while it lasts .

The answer to when to increase depends on your dosing method. Since we're talking TR, then if I were you, and because Niko is very new to insulin, I might hold this dose a little longer than 3 days since he did see (and might see it again soon) blue. A lot can happen in FD in just a couple of cycles.

 

[Niko's Mom]

I see that too. Enjoy the time off while it lasts .

The answer to when to increase depends on your dosing method. Since we're talking TR, then if I were you, and because Niko is very new to insulin, I might hold this dose a little longer than 3 days since he did see (and might see it again soon) blue. A lot can happen in FD in just a couple of cycles.

sounds good, thanks we will try a 5 day hold for now and then consider an increase. appreciate it.