3/26 AMPS 318, +6 458 Any Insight???

[Lisa & Snax]

Hi all, it’s been a bit since I’ve posted! We’ve been barely making it through the days (well, Snax is fine, it’s all my stress).

Anyway, he had a Freestyle Libre on over last weekend before he ripped it right off. My previous recent BG curves with AlphaTrak and his days with the Libre have all confirmed that instead of going down after a shot, he shoots way up.

Our two vets seem confused but pretty unconcerned, since his behavior and overall health are great. Primary vet wanted an AMPS, a +6, and a PMPS to confirm it wasn’t just stress from the Libre, and since it appears it’s not, we’re bumping up from 1 unit (Insulin Glargine, a generic of Semglee) to 1.5 unit.

Basically, what with a +6 hour post-food/post-shot BG rise of 140points instead of lowering, just wondering if this happens or did in the past with anyone else’s hard-to-regulate kitty? It’s not just today, it’s every day we can check multiple times.

I’ve been doing proper shooting, and making sure I don’t smell insulin anywhere after the shot (it’s a strong smell, hard to miss). So I’m almost positive he’s getting his insulin correctly. Also haven’t changed techniques since his late-last-year curves that went the correct direction and were great numbers, if a bit low. Food is one can of FF pate and a little spoon of canned pumpkin these days (high numbers now are no different than high numbers pre-pumpkin, so that’s not it). Recent urine test was super clean, recent blood panel was great.

Any insights into why a daily high spike instead of a dip? Is it really just not a high enough insulin dose?

Thanks all!

Lisa and Snax

 

[Wendy&Neko]

Have you started a spreadsheet to record his numbers? Without looking at the data over the last couple weeks, I can only guess what is happening. My first guess is that he's going lower at night and bouncing during the day, but there could be other scenarios that explain what you are seeing as well.

 

[Lisa & Snax]

So I’m not taking twice daily readings (I know everyone here prefers that, but I’m working with two vets and my kitty to determine what’s best without poking him so much and causing more stress!). So I’ll provide his last curve from two weeks ago, and his numbers from the Libre last week.

Here’s his AlphaTrak curve from Sunday 3/13 (apologies for using times instead of +s, it makes more sense to my frazzled mind):

7:45am: 262
8am: food and 1 unit of insulin
10:20am: 390
12:30pm: 371
2:45pm: 417
5:15pm: 390
7:30pm: 382
8pm: food and 1 unit of insulin


Here are a million reads from the Libre last Saturday 3/19 through Monday 3/21, which also provide middle of the night reads:

—3/19
262 at 10:30am
198 at 12:30pm
379 at 2:30pm
386 at 4:30pm
449 at 6:30pm
487 at 7:45pm
—Supper and 1 unit at 8pm
481 at 9:00pm
304 at 10:30pm
279 at 11:45pm

—NEXT MORNING/DAY 3/20
244 at 2:00am
272 at 4:00am
288 at 6:00am
311 at 7:30am
—Breakfast and 1 unit at 7:45am
332 at 9:00am
350 at 10:00am
338 at 11:00am
364 at 12:00pm
339 at 1:00pm
371 at 2:00pm
350 at 3:00pm
396 at 4:00pm
380 at 5:00pm
322 at 6:00pm
354 at 7:15pm
—Supper and 1 unit at 7:45pm
455 at 8:15pm
442 at 9:00pm
330 at 10pm

—NEXT MORNING/DAY 3/21
182 at 1:00am
217 at 2:40am
239 at 5:50am
283 at 7:00am
315 at 7:30am
—breakfast and 1 unit at 7:45am
284 at 8:00am
280 at 8:15am
294 at 8:30am
315 at 8:45am
332 at 9:00am
355 at 9:15am
334 at 9:30am
328 at 9:45am
303 at 10:00am
277 at 10:15am
275 at 10:30am
289 at 11:00am
314 at 11:30am, read immediately after he ripped off the sensor

Hopefully this helps a bit!

 

[Wendy&Neko]

Any chance you could put this data in a spreadsheet? If you have a hard time doing this, we have people who can help you get it set up. We are all so used to looking at a spreadsheet so it's hard for us to follow just a long string of numbers. How to Create a Spreadsheet:

He does seem to be going down after his PM shot, as many cats tend to do.

 

[Lisa & Snax]

I have a spreadsheet started (from the lovely folks here on the forum), I’ve just been a lazy bum. I’ll input all numbers since I last updated it this weekend!

 

[Wendy&Neko]

Thank you! You'll get faster answers from us once it's set up. Let us know if you need help with this.

 

[Hendrick Cuddleclaw]

Basically, what with a +6 hour post-food/post-shot BG rise of 140points instead of lowering, just wondering if this happens or did in the past with anyone else’s hard-to-regulate kitty?

definitely need to see the data in spreadsheet form but I will say it reminds me of what we went through before we were giving enough insulin to make a difference. Basically the food increases the BG more than the dose can handle, I guess. I'm still a newbie so don't take it to the bank -- just going by what I went through with Hendrick.

 

[Lisa & Snax]

I think I got the spreadsheet link figured out thanks to the detailed instruction links! Tech savvy I am not. It’s in my signature now.

 

[Wendy&Neko]

Good for you on the spreadsheet.

A couple things. First, you need to always get a test before you shoot, to make sure it's a safe number to give insulin. So there should be some data from every single day. Ideally we'd like to see second checks during the cycle, like you did today, to make sure we aren't missing any lows. It's a bummer the Freestyle Libre stopped working on you.

It's possible for a cat to go lower than they are used to, then bounce for six cycles. If you didn't test during the right cycle, all you'd see is bounce number, which are higher. The AM of the 19th, and the PM of the 20th, he did go down in a normal Lantus cycle, so that shows the Lantus is sometimes working as it should. Today looks a lot like a bounce cycle, likely from going lower than he's used to last night.

Next thing, it's possible that he needs an increase in dose. If you could get AM and PM tests for a couple days, then check back in with us, we can council you as to whether you should increase. You've been at this 1.0 unit dose longer than we'd typically hold doses, but I first want to make sure you aren't missing any numbers than would indicate the dose is too high.