4/13 George AMPS 514 +5~302 +9.5~224 PMPS 417

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Alaina and George

Member Since 2012
Good Morning,

I was hoping you guys could take a look at George's spreadsheet and see what you think. Last night George had a preshot of 160 so I reduced his insulin dose to 1u (1.5 usually). If you look at the spreadsheet you'll see that another random time he was low in the evening so I reduced the dose to .5u and he also woke up the next day in the 500's so I increased the dose last night to 1u.

Last night at +4 hours he had a value of 79 so I gave him 3 oz. of food and today he woke up with an AMPS of 514 again.

It seems that every time he gets into better numbers he bounces back much higher.

Do you think he's just not regulated yet or do you think maybe he's on too high of a dose? I wouldn't think it would be too high of a dose because we've increased gradually (except at the beginning going from .5 to 1) but I'm trying to figure out what's going on with these crazy numbers.

Please let me know what you think...

Thanks so much,

Alaina
 
Re: Not Regulated or on too high of a dose??

Alaina:

Given that George tested at a 78 last night, you do need to reduce his dose to 1.25u. When numbers drop below 80 on an AlphaTrack, you reduce the dose. Shooting your usual dose this morning is what we refer to as, "shooting through the bounce." You can do this if BG bounces into high ranges after a number that warrants a dose reduction.

Overall, I think it's going to be hard to answer your question. In order to get a clearer picture of what's going on, you need to get at least one test, in addition to your pre-shot test, as often as you possibly can. Lantus dosing is based on the lowest point in the cycle, the nadir, which is usually somewhere in the middle. Thus, based on the data on George's SS, there's no reason to reduce the dose further especially if you're going to be home to monitor. With Lantus, we typically advise that you post and ask for assistance if you get a pre-shot number under 150 (or 180 on your meter). We can then walk you through the process for shooting lower numbers. Ultimately, you'll want to be comfortable shooting low. It's fine to shoot a reduced dose if you think it's not safe to administer your current dose, which is what it sounds like you've done.

If I had to guess, my best hunch would be that the high numbers you're seeing are due to bounces. When a cat has become used to being in higher numbers, like before the diabetes is diagnosed, those high numbers become the new "normal." As a result, when numbers are falling into much better ranges, the liver and pancreas overreact by pumping out a stored form of glucose (i.e., glucagon) along with counterregulatory hormones. The result is that numbers spike back up. A bounce also can occur if numbers drop fast. It can take roughly up to 72 hours for a bounce to clear.

In general, I don't think the dose is too high. At least in terms of your Lantus use, it's quite likely that it's way too early to expect George to be regulated. I'm presuming that you're using the Start Low Go Slow approach. With SLGS, it's even less likely that George would be regulated in less than one month. That approach will require even greater patience than if you were using Tight Regulation. TR is more aggressive about getting numbers into a better range (and has research to support its success at getting cats into remission).

I'd also strongly encourage you to get a pre-shot test every time you shoot. Otherwise, you have no idea whether it's safe to shoot.

Has George been having problems with nausea? I'm curious why you're giving Cerenia.
 
Re: Not Regulated or on too high of a dose??

It takes a long time to regulate a cat. George's #s could be the result of the medication that he's on, and/or the reduced dose that was given to him on 04/09. The fact that he gave you 514 this morning may be result of the reduced dose from the previous night. Since he's in the higher #s at this time, try and get a ketone test from him to make sure that he's ok. Someone will be along hopefully soon to give you more information than what I can provide. Hang in there. You WILL get there.
 
Re: Not Regulated or on too high of a dose??

It's very discouraging to see those high numbers. You are doing a great job with doing everything. It's a lot! I see you are using the Alpha Trak meter. We generally assume it measures about 30 points higher than a human meter. Plus the strips are way more expensive! Ouch. We used the Alpha Trak for a long time because our vet at the time (who didn't know a whole lot about feline diabetes) used it. We finally switched to a human meter and have never regretted it. I wish we had done it a lot sooner.

Could you edit the subject line of your first post to
4/13 George AMPS 514 Dose too high?

This is so we can quickly scan the board and see what going on with all of the cats. Thanks!
Liz
 
Re: 4/13 George AMPS 514 +5~ 302 Dose too high?

Dr. Czerwonky put him on the Cerenia because of an elevated Pancreas number. She said that it has been known to decrease inflammation in the pancreas.

He is also on Benazepril for high blood pressure, and Zyrtec for allergies which has seemed to help.

I always test preshoot- She said I don't have to but I don't feel comfortable doing that. Imagine if I had done that last night, not reduced the dose, and then not checked him again later.

Sienne, Do you suggest I shoot at 1.5 today in the PM (depending on preshoot number of course), or going down to the 1.25? I was a little confused by your suggestion...

I also purchased the ReliOn Confirm meter and strips to have as a back up and for a comparison sometimes.

I should also tell you that my Alpha Trak 2 meter read 44 points higher than the vets Alpha Trak and also George's blood when I took it to the vet for a comparison.

Thanks!

Alaina
 
Re: 4/13 George AMPS 514 +5~ 302 Dose too high?

I've never done what the vet told me with regard to testing! I test so I have a comfort level and can steer the numbers and for just the reason you mentioned. I mentioned the pre-shot tests because there were some blank PMPS spots on George's SS.

There can be up to a 20% variance in any given test. Depending on where George's numbers were when you tested and the vet tested, that may be within the measurement error. Just as an FYI, the Relion meter should give you results approximately 30 points lower than the results on your AlphaTrack.

If it were me, I'd lower George's dose this evening. When shooting through the bounce, if the test after a cycle where a reduction is warranted has a high pre-shot (like George's test this morning), you can shoot the old dose. After that cycle, you take the reduction. So, George's 79 last night is a reduction-worthy number. Because he bounced to 514 this morning, it was fine to shoot your old dose of 1.5u. This evening, you can reduce the dose to 1.25u.
 
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