29 Aug | Girlie | AMPS 619; +2=689 ; +5=688; +9=677 pm+4=655 All black today; dose increase or wait?

[Girlie's mom]

Condo: http://www.felinediabetes.com/FDMB/...668-2-652-5-295-pmps-371.183029/#post-2030455

Cycle 3 of increased dose of 0.75 after failed reduction to 0.5

Trying to steer her a bit with food to avoid another steep dive of 400+ points again today by +4/+5 which would probably lead to yet another bounce... She's doing what she did the past two days: licking her bowl clean, wanting more food: all atypical for picky Girlie and typical of "about to dive" Girlie...

Update: Have to head into work for a few hours now and won't be back until ca +9. Gave her a little more MC than LC this morning, and she has been steady and hasn't dived - but she's been steady at high black numbers. Not sure what I should learn from this experiment...

 

[Beenie (GA)]

No dosing advise from me....yet Just wishes for Girlie to get her number down...but no DIVING Girlie!!

 

[Girlie's mom]

No dosing advise from me....yet Just wishes for Girlie to get her number down...but no DIVING Girlie!!
View attachment 30631

Oh, I must steal your image! That's gorgeous! I won't show it to Girlie, though, because they all look like they're having entirely too much fun...I don't want to give her any ideas...

 

[Girlie's mom]

Home from work now and her BG @ +9 = 677, so all BG readings were in high black today. Not sure what to do about this. She ate a lot for her today (almost two cans of FF), but it ended up being an equal mix of LC (1) and MC (13) so LC 7.

If she does warrant a dose increase, I can be home with her until +6 to +11 tomorrow (30 Aug); on 31 Aug (US 30 Aug) I have to be at work during her usual dive bombing exploits... @Wendy&Neko any thoughts?

Her numbers today:
+11 = 625
AMPS: 619
Insulin 0.75
+2=689
+3=688
+4=715
+5=688
+9=677

Only other new variable: She got a Zydax injection yesterday for her arthritis and had acupuncture. She's peeing as normal again and also poo'd today. We started the new vial of insulin on am of 26 Aug (which I left out on the counter for three hours...sigh), but she clearly dived that day, the following day, and yesterday. I'm 99.9% certain that she got her shot today and that it wasn't a fur shot. Open to any thoughts/suggestions...

Did a Urinalysis today: no ketones; BG 4+; Protein: trace I've never seen ketones in any of the urinalysis tests I've done.

 

[Girlie's mom]

Zydax info:
Pentosan Polysulfate sodium (a derivative of Pentosan Polysulfate)

Website

In 2013, Girlie started on Zydax 1x/week for four weeks every three months. Last year, she changed to 1x/month injections. She had her last injection in June 2017 before she was diagnosed with diabetes.

 

[Girlie's mom]

@Tricia Cinco(GA) & Harvey I saw that you were up so thought I'd ask you what you might think is going on with Girlie.

 

[Tricia Cinco(GA) & Harvey]

Hi Darrah.

thought I'd ask you what you might think is going on with Girlie.

Good question. Wish I had a good answer. I don't think she's really bouncing off the yellows, as she's been into greens before, but I guess anything is possible.

She has been on this dose for six cycles and hasn't seen anything lower than yellow, so yes, she has earned an increase.

If she does warrant a dose increase, I can be home with her until +6 to +11 tomorrow (30 Aug); on 31 Aug (US 30 Aug) I have to be at work during her usual dive bombing exploits.

So are you saying you will be leaving at +6 and returning at +11, and gone all day the following day?

he ate a lot for her today (almost two cans of FF), but it ended up being an equal mix of LC (1) and MC (13) so LC 7.

Just curious as to why you wanted to raise the carb % today when she was running so high?

 

[Girlie's mom]

Thanks for replying! She does better on a LC 6-9; she dives too quickly with really LC food.

I'll be gone all morning during her peak dive times day after tomorrow (31 Aug Australian).

I wonder if it could have been a fur shot after all?

 

[Tricia Cinco(GA) & Harvey]

I wonder if it could have been a fur shot after all?

Did you sniff her fur? Lantus has a very distinctive odor - like band aids. Even a tiny drop can be smelled. It's entirely possible it was a fur shot. If you think it was, I wouldn't increase just yet. The count starts over with a fur shot, BUT, you'd want to be pretty certain, as we don't want to leave Girlie in these high numbers too long unnecessarily.

 

[Girlie's mom]

Lantus has an almighty horrible smell, in my opinion! I didn't smell her fur this morning (I usually do), but I did run my finger over it, and no Lantus smell (didn't rub her fur, just ran my finger over it). I did check the syringe as I hadn't put it in the recycling container yet, and when I pushed the plunger, there was some left - a drop came out. Not sure whether that's usual or not...
I think it has to be a fur shot somehow, though: she hasn't gone all black like this in a long time, and the food today was the same as the past 3 days since we increased her to 0.75 after a failed reduction...sigh...

 

[Girlie's mom]

Yes re the times away: tomorrow am+6 to an+11, then away the following day am+3 to am+7: not good times to be away if she dives...

 

[Bron and Sheba (GA)]

I think she is bouncing from dropping too fast.
If you look at her numbers on 8/27 she went from 558 to 347 in 2 hours then the next day she went from 652 to 295 in three hours. That's a big drop.

 

[Girlie's mom]

I think she is bouncing from dropping too fast.
If you look at her numbers on 8/27 she went from 558 to 347 in 2 hours then the next day she went from 652 to 295 in three hours. That's a big drop.

Even for Girlie, who loves to dive, that is a big drop... I'm just surprised that she was so evenly in black all day. The only other time she did that was 15 July, and that was when I wasn't testing manually with the AlphaTRAK 2: the Freestyle Libre implant had stopped responding properly and had been giving me error messages since the day before.

Because I wasn't sure about the fur shot, I erred on the side of caution and gave her the 0.75. I smelled her fur afterwards: no fur shot. We'll see what she does tonight, I guess. And I gave her Wellness LC 6 food: no mix of 1/2 LC and 1/2 MC to get a LC 7.

Question re: syringe: I went through a number of my old syringes that I've been keeping aside to use as practice syringes for food colouring, and some of them - even after all this time - had a little drop come out after I pushed the plunger hard. I'm wondering if I'm doing something wrong when I'm giving injections: could there still be a small drop leftover in the syringe even after giving the injection?

I make sure the needle goes all the way in; push the plunger all the way down and keep it there; and then say "one kitty" before I remove the syringe (saw that on a YouTube video somewhere). Could there still be a residual drop leftover?

 

[Bron and Sheba (GA)]

When you give the injection, make sure you are still putting pressure on the plunger as you withdraw it or you will have a tiny drop still in the syringe.
As that huge drop in numbers was only yesterday Girlie could bounce for another 4 cycles. For that reason I would not increase the dose yet.
That is the way I see it. Others may differ.

 

[Girlie's mom]

When you give the injection, make sure you are still putting pressure on the plunger as you withdraw it or you will have a tiny drop still in the syringe.
As that huge drop in numbers was only yesterday Girlie could bounce for another 4 cycles. For that reason I would not increase the dose yet.
That is the way I see it. Others may differ.

Thanks for the tip re: the syringe. I'll be really, really careful about that from now on. Good grief, Darrah! Sigh...

Well, if she wants to stay in higher numbers for two more days, at least she'll be safe while I have to be at physio and then at work the following day...

Having a diabetic cat is entertaining, I'll give her that! Never a dull moment.

I wish I could hire a pet sitter to come in and monitor her on days when I have to go in for work! Maybe there's a vet tech who wouldn't mind getting paid on their day off to watch TV in my house for a few hours during the day and test Girlie when I have to go in for work...hmmm....

 

[Bron and Sheba (GA)]

I wish I could hire a pet sitter to come in and monitor her on days when I have to go in for work! Maybe there's a vet tech who wouldn't mind getting paid on their day off to watch TV in my house for a few hours during the day and test Girlie when I have to go in for work...hmmm....

Good luck finding someone to help with looking after Girlie when you have to work.
That's the hard part. I hope you manage to find someone. Maybe someone older who would like to earn a bit of extra money. You could train them up.

 

[Girlie's mom]

Good luck finding someone to help with looking after Girlie when you have to work.
That's the hard part. I hope you manage to find someone. Maybe someone older who would like to earn a bit of extra money. You could train them up.

We'll see! That would be lovely, though. Perhaps a job in the future for me, eh? Cat sitter for diabetic cats...

 

[Tricia Cinco(GA) & Harvey]

Maybe there's a vet tech who wouldn't mind getting paid on their day off to watch TV in my house for a few hours during the day and test Girlie when I have to go in for work

That is actually a great idea.

As that huge drop in numbers was only yesterday Girlie could bounce for another 4 cycles.

That is certainly a possibility. Since you aren't able to monitor for the next two days, perhaps it is better if you wait to increase the dose. Keep checking for ketones, though!

 

[Girlie's mom]

That is actually a great idea.

That is certainly a possibility. Since you aren't able to monitor for the next two days, perhaps it is better if you wait to increase the dose. Keep checking for ketones, though!

I will keep checking. Thank you so, so much for stepping in with your suggestions and advice. I felt like I was swimming alone there and not sure what to do and it was a bit lonely...

 

[Alicia & Maggie (GA)]

Hope you find a vet tech if that is what you decide to do.
Don't beat yourself up because you aren't already an expert on feline diabetes! Sooo much to learn. Thank goodness for the board.
Hope Girlie gets out of the black soon.

 

[Girlie's mom]

Hope you find a vet tech if that is what you decide to do.
Don't beat yourself up because you aren't already an expert on feline diabetes! Sooo much to learn. Thank goodness for the board.
Hope Girlie gets out of the black soon.

The challenge with Girlie is her dramatic deep dives. I just can't see leaving her when she's so predictably unpredictable...but someone has to pay for the test strips and lancets!
I was half joking about the vet tech; it would certainly be great to have someone who could step in to help or check, though...

I'll try to be more patient with myself. I'll get there - eventually! Thank goodness for this board, though. It would be awful to be sitting here without anyone to turn to for advice and support.

 

[Sienne and Gabby (GA)]

Darrah:

I want to make a suggestion that I suspect you won't like. When you have a couple of days when you're home, can you please stop feeding Girlie anything except low carb food? Providing her numbers don't drop, which they may (and if they do, please post so we can guide your intervening), you really need to get several cycles where you are not giving her MC or HC because you are not going to be home. I think you are seeing such high numbers more due to how you're using food than strictly from her bouncing -- or the higher carb food is acting to accentuate the bouncing. The deep dives may also be a result of your adding high carbs which then wear off and you see a drop in numbers that's propelled by the carbs wearing off. I really think you need to do a curve when you're home and you're not arbitrarily adding higher carb food into the mix as a means of trying to out guess where the numbers will go. This may give you a much better sense of what Girlie's numbers look like.

 

[Girlie's mom]

Hi Sienne,
Right now I'm usually home: I just have to go out for occasional Physio or work 2x/week.

I'm a confused, though: I'm giving her LC food under 10% - usually around 6-7% because if she gets the really LC (under 5%), she's dived quickly and deeply.

So if I mix of 1/2 LC 2% plus 1/2 MC 13%= LC 7%. Tonight, though, I had a food that was a straight LC6% so no mixing to get that LC number tonight. (I know those numbers can vary per individual can, though).

This has come up in previous posts before in discussions with @Wendy&Neko and others. I'm really happy to go back and just try the really LC FF that are 0-2% and I'm not upset with you at all for suggesting that! I'm just confused now...

Just woke up so got a pm+7= 581

I've only given HC or MC straight if a) her numbers have really dived deeply and quickly to low, low greens so I've tried to bring her up a bit or b) I've left some hc as I had to be away for most of the day and she's been deep diving and I've bben concerned that she might dive too low while I'm gone.

Again, I'm not upset at all! Honestly - I'm just thoroughly confused now.

 

[Girlie's mom]

@Sienne and Gabby (GA) I really respect your advice, and I think your cat was a quick deep diver, too, is that right? I so just want to get this right! I can get the condos for previous posts with @Wendy&Neko where this has come up if that helps clarify.

Not upset - not resisting your advice at all! Just confused now...

 

[Girlie's mom]

So, here's my food supply list:

LC %:
FF 0, 1, 2
Holistic select 2, 4, 5, 6 (almost out but order on the way)
Wellness complete health 4, 6
Wellness Core 5, 8 (but not keen on lately)
ProPlan 1, 2, 3

MC - HC %:
FF 12, 13, 15, 20
Wellness Core 13
ProPlan 13, 15, 16

Percentages are from Dr Pierson's 2017 chart. I'm in Australia, but I've checked with Wellness and FF/ProPlan (Purina), and the cans are from the US.

Girlie's pretty picky at times, hence the variety on hand.

Will just wait for your food advice. Should I just try to stick with one food only at a certain percentage for several cycles? If she doesn't turn her nose up, that is...?

It's now 4 am; I'll be home today (Wednesday, 30 Aug) until am + 6; back at am + 10

Tomorrow (Thurs, 31 Aug): away from am+2; back at am +7

Then home for four days straight

 

[Sienne and Gabby (GA)]

If you'll be home for 4 days, I would stick to foods that are low carb. That would mean below 10% carb but most of us use food that's at most 5% or lower (or thereabout). I think this will give you a much better sense of where Girlie's numbers actually are.

Yes, Gabby was a drama queen and her numbers would plummet fast and early.

 

[Girlie's mom]

If you'll be home for 4 days, I would stick to foods that are low carb. That would mean below 10% carb but most of us use food that's at most 5% or lower (or thereabout). I think this will give you a much better sense of where Girlie's numbers actually are.

Yes, Gabby was a drama queen and her numbers would plummet fast and early.

So my 1/2 and 1/2 mix of LC (1) plus mc (13) = LC 7 over the past five and a half days straight (and before that with the one am when I was at work) isn't enough to tell re food and her BG levels, then?

The concensus has been that LLC (0-2%) seem to create too deep dives for her which then cause bounces. Did you think i should give low, low carbs a try again anyway?

Her +11= 561

Thanks so much!

 

[Girlie's mom]

If you'll be home for 4 days, I would stick to foods that are low carb. That would mean below 10% carb but most of us use food that's at most 5% or lower (or thereabout). I think this will give you a much better sense of where Girlie's numbers actually are.

Yes, Gabby was a drama queen and her numbers would plummet fast and early.

As someone who had a diving queen, when would you intervene with some MC food? If I see Girlie diving more than 50-100 points per hour, then I'll try a little mc food as she's shown in the past that LC won't bring her up. She grazes every 1 - 2 hours on LC food, so if she's done a deep dive, additional LC won't bring her up because she dived on that LC food.

Because of the time difference for Australia/North America, most people aren't available to help with food intervention when I ask. Do you have some thoughts on that I could use for future referance?

Again - thanks so much!

 

[Sienne and Gabby (GA)]

I can tell you how I handled Gabby's numbers but please keep in mind, what worked for my kitty may not work for yours. A lot has to do with when a drop in numbers occurs relative to a cat's nadir. The challenge is that given how you've been handling food, it's hard to know where Girlie's nadir typically falls. I would handle drops differently early vs late in the cycle. In addition, Gabby never really saw numbers as high as what you're seeing with Girlie. The other issue to consider is that I had over 6 years of dealing with a drama queen. I am very experienced at dealing with low numbers and they don't cause me to panic or at least past the first couple of times they didn't cause me to panic.

Gabby's nadir typically fell between +3 and +4 (except when it didn't). If it was a weekday, I didn't have much flexibility with my time in the morning, at least on most days unless I called in with a "migraine." I tested early and often. If you'll look at Gabby's SS, I would typically test at +1, +2 and so on depending on where her numbers were. There were times I was testing on the half hour or even more frequently because I didn't trust her not to drop. She also was fed at pre-shot, +1 and +2. Front loading her food helped to soften the dropping numbers given how early her nadir was. Unless there was a precipitous drop, I would first intervene with LC and re-test in 30 min. Based on that information, I would increase the carbs. Gabby couldn't tolerate the gluten in HC food. As a result, I would use either corn syrup or honey to steer her numbers. The numbers of drops of syrup was based on how fast she was dropping. If you look in the comments section of her spreadsheet, you'll see when I was intervening with HC.

All I can tell you is that this isn't an exact science. Fundamentally, you need to operate out of the basic Lantus/Lev Land principle of, "know thy cat." Knowing when onset begins and where nadir falls and how much duration your getting is crucial So is knowing how your cat responds to food. Some cats get a rise from LC food. Others you need to be heavy handed with HC to get numbers to come up.

We do have members in Europe who's times may be more compatible with yours. @Gill & George is often around when the rest of us are sleeping. I don't know if @Bron and Sheba is accessible to you. She's experienced and if you were to send her or Gill a PM, they are likely to get notified via e-mail.