3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS 96,

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Re: 3/15 Boots AMPS 124, +2 111

Welcome to Lantus Land!

It looks like Boots is doing very well. A quick question and a some thoughts.

What does the "h" mean in your dose column (e.g., 1.5h)? I'm guessing you mean "heavy"?

When Boots' numbers fall below 50, a dose reduction is warranted. It looks like you may have missed a reduction or two along the way. There is an exception to taking a reduction in this manner, though. If numbers drop below 50 and you reduce and then, during the next cycle or two they drop below 50 again, what this can mean is that the insulin depot hasn't had enough time to adjust to the reduced dose. You don't want to take dose reductions that close together since it often means that the second reduction doesn't hold.

I think this is what you're seeing right now. In addition, there have been several dose changes within a short period which with Lantus, can result in wonky numbers. This is what I'm seeing:
  • 3/10 --> AMPS dose of 1.5
  • 3/10 --> PMPS dose of 1.5h. I'm not sure why you "fattened" the dose with green numbers.
  • 3/12 --> PMPS dose of 1.0h. This is a BIG dose reduction. Usually reductions are in the amount of 0.25u.
  • 3/13 --> AMPS dose of 1.25u. Two dose changes that are close together.
  • 3/14 --> AMPS dose reduced to 0.75u. There was no indication that the dose was too high and this is a third dose change.
  • 3/14 --> PMPS dose reduced to 0.5u. Again, it doesn't look like numbers dropped below 50 and this is a 4th dose change.

I don't think Boots is bouncing. I think there are too many dose changes that are too close together and he may not be getting enough insulin. You may want to hold this dose for at least 3 days/6 cycles to see how his numbers are after the depot stabilizes. If you're seeing more blue than green, you may need to increase the dose. Typically, you want to hold a dose for 3 days minimum to evaluate the dose. If numbers are consistently in normal range (i.e., mostly in the greens), you want to hold the dose for a week (14 cycles) and then reduce.
 
Re: 3/15 Boots AMPS 124, +2 111

Sienne, it's a long story.... an aggravating one actually. If you go back and read my original post from Thursday night you will see that my vet ("expert") told me my Relion Prime meter was reading 70 pts. (She compared it to her IPet 184)low and that I needed to add that to my reading to get the true BG level. So that is what I did starting Feb. 23. All numbers on the SS had 70 added to the reading. I didn't question the "expert". As of 2 days ago I received a new Arkray Glucocard Vital that came with control solution. I used the solution to verify my reading and both meters were/are accurate. So Thursday night I went back and edited my SS and deleted the 70 back off each reading. That is what you see now (greens). Before, with the 70 added, you would have seen all blues so that is why I was increasing......nadir was never under 100. Yes, there are a few days in which I actually gave 1.5 units when his AMPS were green and I wasn't here to monitor that. I think we were lucky nothing happened. I'm sure he experienced some low 40's and maybe even 30's and would have got a reduction but in my mind his numbers were in the 110's-120's.
That's the best explanation I can give.

Yes, I'm PO'ed about how I treated him, but I believe, with the help I've been given here, I'm going in the right direction now and I'm just hoping I can proceed in the correct manner moving forward.
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87

Hi Dwight!

Glad you made it over to Lantus Land!

Yeah, you've got a complicated little BG numbers history on Boots with the confusion about meters at home and the vet's.

By the way, I started with a Freestyle Lite and I think in lower numbers it is accurate. I definitely don't think they are 70 points less than other meters in the less than 200 range. Over 200, possibly. When i switched (on Punkin's ss if you want to look, it was January 2011) Punkin's lower numbers didn't change much, but the highs showed up. The Freestyle Lite doesn't measure exactly the same way that some of the other meters do, i can't recall what the difference is, but there is one, but it isn't inaccurate per se.

So - i think what would be helpful is for you to insert a line in your ss above say today, and say something like "numbers above may not be accurate" - something like that so people know it's basically starting from now.

For today, however, great looking cycle on mr. boots!
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87

Happy Caturday Dwight and extra sweet Boots!!

I gotta tell you Dwight, that AMPS is one a lot of us would kill for!!! Especially after your adventure into low mans land last night! Usually, when we see a bounce, we see numbers going from the 40's to the 300's or higher. Of course every cat is different (ECID) but I'd barely call that a bounce at all! It's more like a normal AMPS number.

Remember the AMPS is usually the highest number of the day, even in non-diabetic cats.

Looks like a beautiful, safe curve today, so hopefully this .5 dose will be a good, safe one for him. Just hold this same dose for at least 6 cycles unless he drops below 50 again, but I'm betting he'll probably do great on it, and can "earn" his reduction the other way...by staying in normal numbers (50-120) for 7 full days.

Looking good today Boots! Now no more late night drama for your daddybean!! I'm sure he could use a nice relaxing weekend!!
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87

Thanks for checking in Chris. Yes, I, and I'm sure Boots feels pretty good about where he is today compared to a month ago. When I look at the situations that others are experiencing in their SS, I feel very lucky. My other guy is 14 also (given to me as a stray) and basically has eaten the same foods as Boots all of these years so when I received the Relion a couple of weeks ago, and was able to test him, he was 57 then and was at 57 again today. So I'm happy for him having normal levels.

I will hold the .5 and let it play out.

Julie, I bought the new Relion Prime on Feb 23, so everything should be accurate from the PMPS on that day until now. Everything before that was from a borrowed Freestyle that read 40 lower than the Relion. The reason I believe it's accurate is because I also picked up an Arkray Glucocard Vital with solution and 200 strips and I've used them both at the same time with solution, on myself (using same drop)and on my cat and I get virtually the same readings. So the Relion is good to go.
Many thanks to you both.
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS

PMPS 96
Giving .5 units tonight and will monitor for the next 6 hours.
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS

Dwight --

Thank you for the explanation. It helps to put the numbers in context. A small suggestion -- how about putting something in the comments section of your SS indicating that the vet gave you unhelpful info regarding how to "re"-interpret the numbers? (Or, more easily, you can provide the link to where you've explained the situation in detail. Otherwise, I suspect someone here will make the same observation I did and you'll have to repeat yourself (over and over again!). Regardless, Boots' numbers look great!
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS

Hi Dwight,

I don't remember if I've met you - I'm Shelly. My sugar kitty is Jersey. I looked at your SS. Those are some fantastic numbers. Even with the vet giving you the wrong information, you've done a great job. It looks like Boots may soon be OTJ. Yea! :-D

Have a great evening!
Shelly
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS

Sienne, please take a look at my SS and see if the explanations in the remarks section make sense. It makes sense to me.....but I had lived it. It might still be confusing to others.

Shelly, nice to meet you too. Thanks for the vote of confidence.
I've been lurking here for a few weeks but only posted after I figured out my meter was working properly and that I was ODing my cat. He was lucky. I wished I would have figured it out earlier..... but you live and learn and move forward.
Take care.


If anyone is getting any ideas from my SS, PLEASE STOP and do not follow any dosing levels before 3/14.


Thirty min. to +2!
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS

Today's recap.
3/15 AMPS 124 .5 units
+2 111
+4 90
+6 87
+8 105

3/15 PMPS 96 .5 units
+2 63

I hope we're not heading to the 40's again....... :evil:
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS

you can interrupt his descent by giving him some carbs if you want to slow him down.

sometimes we encourage a cat to "surf" meaning hang flat on that number, by giving 2 teaspoons of low carb food. that can be enough to flatten out a cycle.
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS

I agree with Julie, Dwight

Going from 96 to 63 in 2 hours is quite a drop, so you might want to go ahead and give Boots a couple teaspoons of food. See if you can get him up on his "surfboard".

Edited to add...Looks like you got a 73 at +3...that's better! He may have realized his blood glucose was going too low and found his food. There's nothing wrong with him getting food early in the cycle, as long as it's low carb (unless we're trying to get them up higher)

Keep testing though...he may go back down, but you can probably go for an hour since he's in the 70's
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS

The explanation on Boots' SS looks good.

Just an FYI -- the slight rise in numbers between +2 and +3 is probably not a food "spike." Rather, having Boots eat a bit of low carb is encouraging his numbers to stay roughly in the same range (i.e., "surfing") and the LC may have put a tiny brake on the descent. All meters have an allowable 20% variance in any number. So, the 63 and 73 are roughly the same.
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS

Actually Chris and Julie, about 30 minutes ago he got into some Friskies that I had out for my other guy so when I just tested at +3 he spiked up to 73.

But this brings up a question.
Won't giving him food artificially raise his BG as opposed to letting it ride to see where nadir will settle at? I mean, if we feed, and let it rise, we won't know if he would have gone low enough (<50) to know if we need to lower the dose because it was too much from the PM shot. In other words, don't we want to know if his PM dose was adequate or too much and giving food isn't going to tell us? Or, am I over thinking this? I hope that made sense.
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS

Thanks Sienne for looking at the SS.

Just an FYI -- the slight rise in numbers between +2 and +3 is probably not a food "spike.
Click to expand...

My thinking was that at the time between +2 and +3 he would have, without food, went from 63 to somewhere in the 50's or lower as he did last night and that with the addition of food probably increased from presumed 50's to 73. I was thinking that was too much of a gain to just be part of his normal cycle. That's why I was thinking a food spike.
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS

It's kind of a tough question to answer

We don't always want them to go below 50. When they are getting reductions too often, we see that a lot of times, those reductions fail, so you just have to go back up to the last dose that was working.

When they drop between the Pre-shot and the +2, that's a good indication they're going to continue to drop because the insulin really hasn't had a chance to kick in that soon. Remember me telling you about the +2 being what I call a "crystal ball test"? If you had seen that kind of drop on a day you couldn't be there to test, you'd either want to find a way to test in a few more hours, or leave food out so if Boots did continue to drop, he could have some food to eat to bring himself up.

Just curious...you said he got into some Friskies you had out for others. What kind of Friskies? If it was still low carb, it's fine for him to have anyway.

We don't want to force them below 50...When they earn reductions, they earn them. We don't want to rush it. He's still in great, pancreas healing numbers, so we don't necessarily want him to keep dropping lower and lower if we can feed a little bit and keep him "surfing" those great numbers. Remember, he can also earn his reductions by just staying in those great numbers for 7 days. We want to give his pancreas as much time as possible to REALLY rest, and then kick back into gear. Rushing the reductions could end up causing him to go OTJ too soon, and you'd rather have him get into a strong remission and hopefully be able to stay there for the rest of his life, than try to rush it and have it fail. A 2nd remission is much harder to get than a first one.

Boots is doing great, and I don't think any of us think he'll be needing insulin too long, but we do want him to get that strong remission, so we don't want to rush the reductions
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS

Makes sense. Great explanation Chris.

I'm happy he has responded so well. His +3 was at 77. I'll probably do a +4 and if safe, call it a night. I need the rest.

As far as the Friskies go....I'm only feeding the Spec. Diet. Turkey and gibs. and only because it has lower phosphorous. I feed it exclusively to both of my felines.
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS

i fed that Friskies to punkin - it's either 4 or 5% carbs, i think 4%. it's fine for him to have.

i was also suggesting the little bit of food in response to your comment that you hoped he wouldn't go into the 40's again tonight.
 
Re: 3/15 Boots AMPS 124, +2 111, +4 90, +6 87, +8 105 PMPS

+5 77

i fed that Friskies to punkin - it's either 4 or 5% carbs, i think 4%. it's fine for him to have.
Click to expand...

I've tried lots of different LC foods in the last month and only after learning that Boots' BUN and creatinine levels were slightly elevated did I settle on the low phosphorous Friskies SD Turkey & Gib. All of the other LC stuff has higher phos. inc. 9 Lives and FF Classic

Calling it a night. I'll be back for AMPS in a little over 6 hours. Hoping for another good day tomorrow.
 
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