4/26 Lucky Curve AMPS 398 PMPS 271 & Questions

[Luckyducky]

Hello again everyone! I just finished another glucose curve for Lucky's week-long dosage at 1.25u bid, and again have some head-scratching results. Here's his spreadsheet again for reference.

AMPS 398
+2 393
+4 376
+6 287
+8 272
+10 303/350
PMPS 271/238
+2 262/273
+4 268/243
+6 333/335
+8 392/401
+10 354/352
AMPS 309

The second set of numbers after the +10 mark comes from a set of readings I took testing out a new inexpensive glucometer that had just arrived in the mail (the Arkray Vital). I was wondering what everyone's thoughts were on the two sets of readings, since they seem somewhat different, but maybe not significantly so (?)

Anyway, the thing that confuses me about this curve is how similar it is to Lucky's last glucose curve (which was at a lower 1u bid). Both curves started in the 300's and sloped down all the way through most of the AM cycle, and even further during the PM cycle. Is this kind of curve normal? I was hoping that the AM and PM cycles would finally look similar to one another, especially since Lucky is finally getting the same amount of calories during both cycles now (1 3/4 cans in both AM and PM). Do you all think maybe something else might be going on here that I'm not noticing?

There is one relief about the 1.25u bid dosage, though, in that I've seen significantly fewer readings in the 400 range since I increased the dosage. I was thinking of increasing the dose again to 1.5u to see if I can finally get Lucky's numbers out of the 300 range altogether, but was wondering what everyone's thoughts might be in case these readings throw any warning flags I should be aware of.

One other thing I thought I should mention is that Lucky seems to be less hungry in recent days. His weight has stayed at a constant 12.2 lbs, which I'm guessing may be a bit on the light side considering how large he is. It used to be that he would ravenously eat through all his food, but now he seems to instead eat 3/4 of it and then loses interest. I'd say he's eating a little under 3 cans/day now instead of the 3 1/2 I've set out for him, and I wonder if that's at all a cause for concern or sheds any light on his glucose readings. He also seems to be urinating less frequently, which seems to be a cause for some relief I'd think.

Again, I can't thank you all enough for all the help you've given these past few months. It really is appreciated, and I wish you all the best.

 

[Marje and Gracie]

I think the curves are similar because he needs more insulin. Are you doing th tight regulation or the start low go slow protocol? If you are doing TR, you should be increasing the dose every 3 days ( six cycles) while he's high and flat like this provided he does not come down into blue or green or bounce. If you are doing SLGS, you would hold the dose one week before increasing if he's not getting into normal numbers although reductions are given for snu umber under 90 for that protocol.

He's probably eating/peeing less because he IS now getting insulin in his system.

So...unless he comes way down tonight, regardless of the protocol because you are past size cycles at this dose, I'd take him up to 1.5u tomorrow and test!

 

[Luckyducky]

Right now I've been going with the Start Low Go Slow approach, holding the dose for a week, then doing a curve to see how the insulin is holding up, and then changing the dose based on the results. I'd like to do Tight Regulation, but the time and financial constraints are too much for me atm (I'm still figuring it out though, and might change to Tight Regulation in the future), so I'm doing as best I can with this approach for now.

Thanks for your advice too, I increased his dose this morning and hopefully I'll start seeing better results soon. I've been scratching my head about Lucky's readings lately, since they were dropping really low 2 months ago on 1u bid, but recently seem to be staying in the higher ranges even on the higher 1.25 bid. It seems counter-intuitive, but I guess that's just the nature of diabetes and Lucky's reaction to insulin? Well, hopefully this increase will keep improving his numbers, and I'll keep up with the monitoring and see. Thanks again, and if anyone has other thoughts or insight to chime in, it would also be greatly appreciated too.

 

[julie & punkin (ga)]

i'm agreeing with marje that he needs more insulin - i'm glad you increased his dose this morning.

you are testing enough to follow the TR protocol. it needs the preshot test and a mid-cycle test, and whenever the cat gets into lower numbers, then you have to test enough to make sure they are safe.

i haven't heard anything bad about the Vital glucometer and several people have mentioned it.

if he continues to stay in yellows, pinks and reds, after 6 cycles you will want to increase. that's based upon the TR protocol - the trouble with letting a cat hover too long in high numbers while you wait a week on the SLGS is that cats develop a tolerance to whatever level they are at and then it takes even more insulin to get them down. your choice on how you want to proceed - if it's SLGS, wait a week, do another curve and let us look at it. if it's TR, wait 6 cycles and have someone look at the nadirs to see what's next.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

here's a link to a collection of articles i pulled together about feline diabetes and glucose toxicity.

 

[Sienne and Gabby (GA)]

I agree with Marje and Julie. The curves look similar because more insulin is needed. Also, your meters are running very close. Remember, there's about 20% variance with each meter so they are giving you pretty much the same numbers. It's possible you may see some differences on the low end but in these mid-range numbers, they look almost identical.

For the amount you are testing, you could easily use the TR protocol. If you don't mind my asking, what are the financial constraints you alluded to? As long as you can get pre-shot and at least one test per cycle, which is roughly the same for TR vs. SLGS, there wouldn't be any difference in cost. It looks like you're feeding canned food, so there's no additional cost from that. Unless there's something else, you could use either protocol.

 

[Amy&TrixieCat]

i haven't heard anything bad about the Vital glucometer and several people have mentioned it.

I just want to add that we recently switched to the Vital and I LOVE it. It's solid, accurate, reliable, and you can't beat the price of the strips (with the "Buy 4, Get one Free" deal through ADW, 250 strips are 49.99 -ish). I wish I discovered it when Trix was diagnosed last year!

Good luck with the increase!

 

[Luckyducky]

Oh wow, I didn't know I was taking enough tests to do Tight Regulation already, I figured the TR protocol would require a lot more than 2 pre-shot and 2 mid-cycle tests. I guess that kind of worries me, since if I don't get enough glucose readings at the right times, I might miss Lucky's nadirs and dangerously increase his dose (it also seems that Lucky might be rebounding on his doses, which would have me doubly worried I might not be getting enough data). Would it be okay to instead do a full curve every 5 days, instead of every 7 days, and change the dosage after that? I'm pretty sure I could manage that, though I don't know if it's considered okay in either of the approaches.

My financial constraints are a bit complicated to explain. I used to be a software engineer several years ago, but left in order to pursue a living doing art instead. So far I've been surviving off of personal savings, but Lucky's emergency medical treatment ate into a large part of that. Since the continuing costs for Lucky's treatment are decreasing my savings more and more, I've decided to put some of my artwork on hiatus and return to software engineering in the next few months. I figured the extra testing for TR would be too expensive to manage, but if I'm taking enough tests as it stands, maybe I can go for it. My only other worry would be when I return to software development, I likely won't be able to do mid-cycle testing anymore.

It's great to hear that the Vital meter appears to be consistent with the ReliOn meter. It's significantly less expensive, and even though it doesn't have the same beeps and features as the ReliOn, it's just as simple to use.

And that collection of articles on feline diabetes and glucose toxicity has been enlightening to read so far. I was getting the impression that Lucky might be developing a tolerance for the higher numbers, which might be making the insulin less effective, and those articles have especially got me thinking about the dangers associated with prolonged glucose toxicity at those higher levels.

Last night I got some funky readings on the new dose and decided against the PM shot. The numbers seem to suggest that the Lantus might be hitting its nadir after the +12 mark, around +14, which is surprising and makes me wonder how it might have been affecting his readings on prior dosage amounts. I'm continuing with the 1.5u for now, and I'm going to try and collect more data tonight at the +1, +2 and +3 marks to see if he dips low at the start of the PM cycle again.

Again, thank you all for your insight and help, Lucky and I both appreciate it. :smile:

 

[julie & punkin (ga)]

hi joe!

glad you've posted tonight - it looks like what's going on is that lucky is now doing some bouncing. cats often get lower numbers at night, and it looks like he's hitting some fantastic numbers in the 60's, and his body is reacting by causing a bounce. his body has gotten used to the higher numbers and when he's getting back into good numbers, his body is letting loose sugars and counterregulatory hormones to increase his blood sugar.

that will stop - as lucky gets into the green numbers more, his body will begin to recognize that as safe and will stop reacting to it. it's not an issue of a changing nadir - bounces override a "normal" curve. when the bounce clears, the regular curve returns.

it looks like you've hit a break-through dose. that little bit of an increase was a good choice. for now, you want to hold this dose and let's see what it does.

if there's any way you can post every day, we'll be able to give you some quicker feedback to guide you in caring for him.

i want to make sure that you have this post on how to handle things if you see a lower-than-you-are-used-to preshot number. Shooting & Handling Low Numbers It's at the top of this forum in a yellow starred sticky. a lot of people will post here if they see a preshot number that alarms them and seek help on whether or not they can give the insulin.

Lucky is now having some action, so i just want to encourage you to keep posting so we can help you get him regulated as quickly as possible.

btw, i think what sienne was asking was about whether or not you thought that following the TR protocol was more expensive than following SLGS. The phrase "tight regulation" means that we are trying to keep our cats in good blood sugar range - that of a normal, non-diabetic cat. the reason for that is that it allows the pancreas to heal, and if we are lucky at all, the cat to go off of insulin. if not, it still keeps the cat in a healthier condition. People who are experienced can "read" lucky's ss and see what he's doing in between tests. you don't have to test a zillion times a day for things to become clear. lantus has a fairly predictable nature.

 

[Luckyducky]

Thank you so much for the thorough information Julie, all of your advice is really appreciated. :smile: It's nice (and scary!) to see Lucky finally getting back into the greens, and he's been so long in the pinks/yellows that it's surprising how sudden the good colors snuck up. I was also thinking, looking at Lucky's numbers, that he was bouncing too, mostly based on the sudden jump from green to yellow the other day. It's good to hear that it will level out eventually, and I'll definitely stay the course with Lucky's 1.5u bid dose for now (keeping my fingers crossed it'll level out well!)

As for Tight Regulation, well, I guess I don't feel ready for it yet. I'm overly cautious by nature, and part of me is too worried about dosing without a full day's curve data, which is why I'm a bit more comfortable with the SLGS and weekly curve for now. But not just that, it's been incredibly difficult for me to find time to visit the forums on a regular basis. I wish I had the time to post every day, but right now there's just too much going on in my personal life that frequent posting isn't going to be a possibility for a while yet. I'm going to at least try and chime in once/twice a week, and of course after the weekly curve too... I really hope that will work well for Lucky, I want what's best for him but I'm not sure I can manage more than that.

Thanks so much again for all the help and guidance. I'm amazed at how dedicated you all are to help people every day on these forums, it's such an incredible effort and an enormous help you're all doing here. Thanks again, from both Lucky and me!

 

[julie & punkin (ga)]

you're very welcome - the people here donate time to teach new people because others taught us how to help our own cats and we all know how much it's needed.

just let us know how we can be of help to you and Lucky!