31 Dec | Girlie AMPS 562; +7=90; +8=68; PMPS 115; +2=92

[Girlie's mom]

Condo: http://www.felinediabetes.com/FDMB/threads/30-dec-girlie-amps-207-4-131-5-83-7-122.188781/

30 Dec (yesterday), no huge bounce from dive on 29 December, but last night and today, big bounce up to high numbers again: which means she'll dive again today if she goes down.

Cycle 6 of the 0.1. I assume the depot leftover from the 0.25 is long gone, especially as so many shots were skipped on that dose. We'll see how she goes!

 

[Girlie's mom]

I don't think this is a matter of loss of duration. I think Girlie is bouncing. Girlie dropped from the 600s to 81 by +6. Dropping below 50 isn't the only reason for a bounce. A big drop like one of 583 points will trigger a bounce in most cats. Low numbers, fast drops, or a big change in numbers can all cause a drop in numbers.

Are you really following TR? And if so, does it make sense for you to do so if you're recovering?

Hi @Sienne and Gabby (GA) : I'm not sure why you're asking whether I'm following TR. Is there something that indicates that I'm not?

I'm at home: she'll dive and bounce no matter what I do, I'm afraid, especially as she's now starting in numbers over mid-yellows.

 

[Sienne and Gabby (GA)]

The reason that I asked is that Girlie dropped to 49 on 12/26. I realize she was at the vet and frankly, I haven't a clue what the vet was doing. It looks like your vet was attempting to dose Lantus they way you would with a short acting insulin (i.e., it looks like Girlie got 3 shots that day). Did you drop the dose once Girlie was back home? Going back to 12/17, you reduced the dose at the PM cycle. With TR, if nadirs are mostly below 200, you would hold the dose for 5 days/10 cycles. It looks like it was a judgement call as to whether most of the nadirs were in blue or lower numbers. If you knew you were going to be in the hospital, I wouldn't have increased the dose but Girlie was due for an increase.

I'm very familiar with a cat that dives early and often. It looks like you're trying to intervene with food, which is good. One thing that may help to consider is to try to maximize the amount of insulin and intervene with higher carb food. You may not want to mess around with medium carb when you see some of those fast or big drops. If you think it would be helpful, take a look at Gabby's SS. She was a diving diva!

 

[Girlie's mom]

The reason that I asked is that Girlie dropped to 49 on 12/26. I realize she was at the vet and frankly, I haven't a clue what the vet was doing. It looks like your vet was attempting to dose Lantus they way you would with a short acting insulin (i.e., it looks like Girlie got 3 shots that day).

Thanks, Sienne!

Girlie is on Levemir, not Lantus. She's been on Levemir since 11 Nov 2017.
I put in the Remarks column that the vet was feeding Girlie m/d and that Girlie was barely eating. Don't know how that could be as she didn't lose any weight while in hospital.
No, re 3 shots on one day. My SS has been messed up for a while; it took the number from row 236 instead of row 235; I've just corrected that manually.
24 Dec: 0.25 at 7 am/7 pm; dive to 49 at PM+6 and 25 at PM+10
25 Dec: No shot AM or PM
26 Dec: 49 at AMPS (7 am): No AM shot
26 Dec: 0.25 at 3 pm after she came up to 205@ AM+8 on 26 Dec. Girlie now on 3 AM/PM schedule

Why they didn't reduce her dose is beyond me, unless they couldn't figure out how to read 0.1 on a 1/2 unit syringe.

Did you drop the dose once Girlie was back home?

Yes, I did. I got her home on PM of 28 December. You can see on the SS that she got 0.1 at 1 pm (vet's schedule). She was due her next shot at 1 AM; I skipped that and gave her 0.1 at 7 am of 29 December.

Going back to 12/17, you reduced the dose at the PM cycle. With TR, if nadirs are mostly below 200, you would hold the dose for 5 days/10 cycles.

Girlie is on AlphaTrak2, so at +4 of 17 December, she dropped to 66 (below 68) which on AT2 means a reduction, which is why I reduced to 0.25 in the PM cycle.

If you knew you were going to be in the hospital, I wouldn't have increased the dose but Girlie was due for an increase.

I was not planning to go to hospital; I went via ambulance so didn't have much choice in the matter.

It looks like you're trying to intervene with food, which is good. One thing that may help to consider is to try to maximize the amount of insulin and intervene with higher carb food.

Yes, quite some time ago @Marje and Gracie was helping me try to learn how to stall and steer Girlie. I put the carb % on my SS so it's easy to see at a glance what % of carb food she got and how much she dove or came up. 12 - 16 December is interesting if you want to look at the effect higher carbs has on her, especially at night.

I thought that the stress of being in hospital would raise BG levels. Can not eating much drop BG levels as dramatically as hers dropped while at the vets? Or could just the stress of being in hospital drop BG levels?

I need to figure this all out as I'm going away at the end of February for two weeks (less if I need to come home early for her), and I need to know how to make her safe while she's at the vet's.

 

[Girlie's mom]

@Sienne and Gabby (GA) , what I do NOT understand is what the vet did on 27 December (unless I read the numbers she gave me incorrectly):
27 Dec: 0.25 @3 am; then 0.25@ AM+10 (1 pm) - 2 hours early: That looks like someone who doesn't know anything thought that giving Levemir when she was going up might stall her. Fool.

Here in Australia, many vets haven't even heard of Levemir. Hard to believe, I know, but true.

 

[Girlie's mom]

Doing well here. I wonder if you can nap, and maybe find some assistance with meal preparation and house keeping?

Glad to hear you're doing well, @Kathy and TiTi I'm on my own, I'm afraid. Flatmate is on holiday. So it goes!

 

[Girlie's mom]

With TR, if nadirs are mostly below 200, you would hold the dose for 5 days/10 cycles. It looks like it was a judgement call as to whether most of the nadirs were in blue or lower numbers. If you knew you were going to be in the hospital, I wouldn't have increased the dose but Girlie was due for an increase.

Hi Sienne. Are you talking about 17 - 23 December? All of her nadirs (lowest points, right?) were blue or green. I understood that she was bouncing and so was wearing patience pants - thank goodness. Who knows where she would have ended up at the vets if I'd increased her dose before I had to go to the emergency room.

Is it the AMPS and PMPS during this period (17 - 23 Dec) that makes you think she should have had a dose increase (if I hadn't been rushed to hospital)? Just curious - thanks!

 

[Girlie's mom]

One thing that may help to consider is to try to maximize the amount of insulin and intervene with higher carb food.

Hi Sienne - I'm not sure what you mean by "maximize the amount of insulin." If you have a moment, could you clarify that for me? Do you mean intervening early with higher carb food (e.g. 15+ carb) in the +2 or +3 time (even though she'll be going up, still, on Levemir as that doesn't really kick in until +4 or so for her)?

Thanks so much!

 

[Girlie's mom]

+8 = 68 (borderline for AT2). I don't understand why she's dropping so low... I know from before that if she starts high, she'll often have a later nadir (as today). I'm just surprised to see her drop so low on 0.1 after so many NS (4 at the vet's in 5 days) and one NS with me to get her back on schedule. And I did give her 12% food today in the AM.

The Levemir kicks in at +4 (usually). I wonder if I should give her MC/HC food at +2 or +3 even if her numbers are still going up (as they usually are at +2 and even +3)?

 

[Tracey&Jones (GA)]

She seems like she is on a mission. Maybe give higher carb at shot time and +2? Get the carb up before the onset and then maybe she won't go so low?

 

[Girlie's mom]

PMPS = 112
PM+2 = 92

The Levemir hasn't kicked in yet, so I've given her 16% to try to boost her up before the +4. I find what her numbers are doing so interesting today. I can't really figure it out, though. It's cycle 7 now of the reduction t0 0.1 of Levemir; I'd think the 0.25 wouldn't be in play anymore, especially with the NS, but perhaps it is? Hmmm...

It's New Year's Eve here for me in Australia. I hope to be well asleep before the fireworks go off, though! I hope everyone has a happy, safe New Year's and a wonderful 2018...

 

[Sienne and Gabby (GA)]

Thanks for clarifying. I didn't register the AT meter and I automatically type "Lantus" rather than Lev. Sorry.

When trying to have an effect on bouncing, the idea is to try to keep the kitty in blue/green numbers as much as possible. With cats that only seem to want to bounce, given a drop into lower numbers, their pancreas and liver panic, and shoot numbers back up again. One theory is that is you get as much insulin as you safely can into your kitty and increase the carbs as you need to, you will theoretically have your cat's numbers in an overall lower range. You aim for a blue pre-shot and a green cycle. I tried this with Gabby and found it took a few weeks to see an overall change. It was by no means an overnight response. Also, I didn't really use food of varying carb amounts. I used corn syrup or honey to raise Gabby's numbers. (She was sensitive to gluten so I went for syrup. I varied the amount by number of drops of syrup.) Gabby also had a very early nadir. Her numbers could start to drop at +1 or +2 with her nadir usually being at +3. If I saw a drop by +2, I was reaching for the HC. This was allowing me to prevent a dose reduction which is the goal since your keeping your cat in blue/green numbers. One other thought may be to use a higher carb food (e.g., 5 - 8%) as your basic food all the time and add HC if you need to. Some cats actually do better with a baseline of higher carb food than a food that is 0 - 2%.

I was referring to the period around the middle of Dec. but I wasn't factoring in that you're using an AT meter. Also, "patience pants" tends to mean to hold the dose. However, if you need to increase and increasing in in keeping with the protocol, it's fine to do so. If may be a matter of it looking like a bounce is breaking and increasing the dose at the same time that a bounce is breaking could cause numbers to plummet due to the combined momentum of the two factors.

Let me know if this makes sense.