4/5/22 - KeyKey - AMPS 134

keykey

keykey

Member Since 2022
Previous Post: https://www.felinediabetes.com/FDMB/threads/4-3-22-keykey-amps-179-146.261516/

Just looking for some advice on this one. This is the lowest her AMPS has been (134). I shot 0.25u when her PMPS was 132, but that was using my Cera-Pet feline glucose reader, which I know reads higher than the human ReliOn meter I'm currently using.

This reading was done before she's eaten. She's eating now and I'll take another reading in about 20 minutes, right around the time I would give her her shot. What should I do? I don't like seeing it this low when I'm about to give a shot. The last two nights I saw a pretty good curve back upwards by the morning, but this morning she seemed to stay pretty stable throughout the night and into the early morning.
 
I assume I should just stick with it, and monitor for anything that goes below 90, and be ready with some gravy high carb wet food if I see those kind of numbers?
 
keykey said:
I assume I should just stick with it, and monitor for anything that goes below 90, and be ready with some gravy high carb wet food if I see those kind of numbers?
Click to expand...
Bingo!

We save high carb for below 50, or steep/early drops. Try to let her "surf" with low carb snacks. She's not much of a diver (knock on wood) so I think you'll be ok with low carb food.
 
Last edited:
Also with regard to meter - the 132 on a human meter would be higher on the CeraPet (there's no conversion as you know, but if I had to hazard a guess the CeraPet would read somewhere around 140-160).
 
FrostD said:
Bingo!

We save high carb for below 50, or steep/early drops. Try to let her "surf" with low carb snacks. She's not much of a diver (knock on wood) so I think you'll be ok with low carb food.
Click to expand...
I just got a reading of 82. (She went from +2 at 125, to +3 at 82)
Sorry, I misunderstood your initial "bingo" and gave her some gravy high carb for just a second while I re-read your post. Re-reading it, I saw you meant below 50 give high carb, so I pulled it up from her. She only had a few licks.

So she's good under 90 to continue just eating the low carb, and only at 50 should I break out the gravy train? lol
 
Sorry I should have been more clear/separated out the quotes. No harm no foul. Yes, low carb for now.

So now you have a decision to make. The next reduction in SLGS is either down to 0.1U or a drop dose...with your syringes it would probably have to be a drop.

You push plunger down hard as you can, insert into the pen/vial, and release the pressure - result is a single drop of insulin just in the needle, not visible in syringe. When you give the shot, have to push down hard as you can and hold it in for as close to 10 seconds as you can get to let it absorb.

That said, still too much blue in her spreadsheet at this dose (for remission we want them 50-100 on human meter nearly all the time...ideally no blues at all). So at this point I'd recommend a change to TR, because it will allow you to hold this dose longer - which will let her numbers keep coming down and let her pancreas heal
 
FrostD said:
Sorry I should have been more clear/separated out the quotes. No harm no foul. Yes, low carb for now.

So now you have a decision to make. The next reduction in SLGS is either down to 0.1U or a drop dose...with your syringes it would probably have to be a drop.

You push plunger down hard as you can, insert into the pen/vial, and release the pressure - result is a single drop of insulin just in the needle, not visible in syringe. When you give the shot, have to push down hard as you can and hold it in for as close to 10 seconds as you can get to let it absorb.

That said, still too much blue in her spreadsheet at this dose (for remission we want them 50-100 on human meter nearly all the time...ideally no blues at all). So at this point I'd recommend a change to TR, because it will allow you to hold this dose longer - which will let her numbers keep coming down and let her pancreas heal
Click to expand...
Sorry, I'm rather confused reading your post. You're saying if I stick with SLGS I should do either the .1u or drop dose, but you're recommending that I don't stick with SLGS and instead change over to TR? Again, I've been trying to read the stickies on the methods but am entirely unclear what they actually entail.

So if change and go with TR, I just continue with the 0.25? Whereas with the protocol of SLGS based on these most recent numbers I would drop the dosage as this point?
 
keykey said:
So if change and go with TR, I just continue with the 0.25? Whereas with the protocol of SLGS based on these most recent numbers I would drop the dosage as this point?
Click to expand...
Correct.

She would benefit greatly from TR and being able to stay on this 0.25U dose longer or possibly a slight increase once the week is up (TR reductions are below 50 on a human meter).

SLGS yes you would have to reduce your dose starting with tonight's shot.

It truly is what works best for you, but she's got a good chance at remission if you can make TR work.
 
FrostD said:
Correct.

She would benefit greatly from TR and being able to stay on this 0.25U dose longer or possibly a slight increase once the week is up (TR reductions are below 50 on a human meter).

SLGS yes you would have to reduce your dose starting with tonight's shot.

It truly is what works best for you, but she's got a good chance at remission if you can make TR work.
Click to expand...
So the objective of TR is basically getting to those 50-100 numbers quicker, with it being more demanding on the testing side/possible going to low too fast?

And the aim of SLGS is basically giving the doses, and adjusting them as need be, to kind of lower those numbers gradually over a period of time? Benefits being it's less demanding on the testing side/less risk of going too low too fast, but drawbacks being you're not as likely to achieve remission sooner?

So if I were to go with TR, I just continue with 0.25u with the aim of having most all of her numbers between 50 and 100. If she goes below 50, I make sure to give her gravy food to bring BG back up, and reevaluate dosage at that point.
 
keykey said:
So the objective of TR is basically getting to those 50-100 numbers quicker, with it being more demanding on the testing side/possible going to low too fast?

And the aim of SLGS is basically giving the doses, and adjusting them as need be, to kind of lower those numbers gradually over a period of time? Benefits being it's less demanding on the testing side/less risk of going too low too fast, but drawbacks being you're not as likely to achieve remission sooner?

So if I were to go with TR, I just continue with 0.25u with the aim of having most all of her numbers between 50 and 100. If she goes below 50, I make sure to give her gravy food to bring BG back up, and reevaluate dosage at that point.
Click to expand...
Pretty much correct.

SLGS often "ties your hands" with regard remission because reducing for drops under 90 are counter to the idea of remission, it keeps their numbers higher overall.

TR is more demanding with testing mostly for safety, because you're pushing them to the lower numbers. When close to remission it's usually not big fast drops, it's more trying to gently keep them green as long as possible
 
FrostD said:
https://docs.google.com/spreadsheets/d/100Ds8kRzVasuyyhQ1oqx6-Xx_wA_8LZINb4Kb4NUpoU/edit?usp=sharing

Wolvi is currently doing an OTJ (off the juice) trial. He came down in dose more quickly than usual, but you can still see his spreadsheet as an example.

(My cat is also in remission, though my spreadsheet isn't a perfect example because he had a secondary condition we did treatment for that got him into remission)
Click to expand...
Okay, yeah, I see...around that second week of March your cat starting hitting all those green numbers back to back.

If I understand your chart correctly, it looks like you were lowering the dose though, and eventually lowered it to that drop methods you spoke of earlier in this thread? Would your method at that time still be considered TR though, because you were lowering the dosage? I'm a little confused.

Just trying to understand things, was it that because you were consistently hitting those green numbers, you decreased the dosage to see if the numbers would maintain, and by doing that you were seeing an opportunity to achieve remission?

..and when you did hit those lower numbers, right under 50, did you feed the MC food (had to look that up) to get the numbers back up, and test more frequently, like you did on March 20th?
 
This answer will be more than you bargained for lol

In short the rules are a little different for high dose cats like mine with other underlying conditions, and my cat is a complicated kitty

My cat has acromegaly, which is a pituitary tumor that secretes growth hormone. Coincidentally, that hormone binds to the exact same spot insulin needs to bind to (the body's own insulin, or exogenous insulin like we use here). Therefore, it requires a much higher dose for the insulin to get through and manage BG.

He started medication for the acromegaly, it works by stopping/lowering production of that growth hormone. No/less growth hormone means more insulin gets through - hence those huge reductions you see in my spreadsheet in July.

Now the March date you're referring to - he was sick at the time with pancreatitis. He also has a condition called IAA - where his antibodies attack exogenous insulin :rolleyes: My theory there is when he gets sick, those antibodies that normally fight the insulin have to leave and fight off the infection instead, which results in drastically lower insulin requirements .

April 4, 2021 is a better example. He was better, back to full dose. You can see that night I had to intervene with food, it was a big early drop. Ideally I would have tested again after that, but I had a new (human) baby so just set out some high carb food.

But in summary - you'll learn your cat pretty quickly. Take a look at Hendrick's thread today. Kyle is still pretty new here, but he knows Hendrick well enough to know what to feed and when. Little Man is another good example. We definitely help you with what to feed and when for awhile!
 
FrostD said:
This answer will be more than you bargained for lol

In short the rules are a little different for high dose cats like mine with other underlying conditions, and my cat is a complicated kitty

My cat has acromegaly, which is a pituitary tumor that secretes growth hormone. Coincidentally, that hormone binds to the exact same spot insulin needs to bind to (the body's own insulin, or exogenous insulin like we use here). Therefore, it requires a much higher dose for the insulin to get through and manage BG.

He started medication for the acromegaly, it works by stopping/lowering production of that growth hormone. No/less growth hormone means more insulin gets through - hence those huge reductions you see in my spreadsheet in July.

Now the March date you're referring to - he was sick at the time with pancreatitis. He also has a condition called IAA - where his antibodies attack exogenous insulin :rolleyes: My theory there is when he gets sick, those antibodies that normally fight the insulin have to leave and fight off the infection instead, which results in drastically lower insulin requirements .

April 4, 2021 is a better example. He was better, back to full dose. You can see that night I had to intervene with food, it was a big early drop. Ideally I would have tested again after that, but I had a new (human) baby so just set out some high carb food.

But in summary - you'll learn your cat pretty quickly. Take a look at Hendrick's thread today. Kyle is still pretty new here, but he knows Hendrick well enough to know what to feed and when. Little Man is another good example. We definitely help you with what to feed and when for awhile!
Click to expand...
Wow, that sounds like quite the handful. The things we do for those we love!
 
Just popping in since I don't see new threads - do you by chance feed anything after around +6?
 
FrostD said:
Just popping in since I don't see new threads - do you by chance feed anything after around +6?
Click to expand...
Hey, sorry...just seeing this now. I've just been continuing your advice on the TR, sticking with 0.25u and watching those numbers. She seems to be coming down, showing more greens and sticking closer to those lower blues than the higher blues she was just showing two days ago.

When you ask "feed anything after around +6", are you asking +6 after AM shot, or PM shot?...I'm basically feeding her throughout the day. I try to make it so the only time she doesn't really have food is about an hour to 2 hours before dinner. As for breakfast, I usually go to bed with a little bit of food still left out for her so she's not starving by the morning, but she's still hungry enough to eat before her shot.

The way I wrote that make it sound like she's eating all the time, but she's not eating a terrible amount. She's still just a grazer. She'll eat most of her food (half can) before her AM/PM shot, but she's just moderately grazing throughout the day.
 
+6 either cycle. The reason I ask is she climbs a bit quickly in the later part of the cycle, so I was wondering if perhaps she was having more than a small snack or so after +6. Carbs after nadir tend to make them climb a little more quickly. A small snack or two is ok if they can't make it that long.

That said, she had a very nice flat last part of her AM cycle today, so fingers crossed she just needs a bit more time
 
Hopping over here from our PM to give the dose advice for tonight - the two numbers tonight are effectively flat (meter variance).

Since you have to be up early and need sleep,.you can always skip. I don't think it will hurt her much at all. That said, she's always been higher at night, so you could take the gamble that shooting the 100 will keep her fairly high greens. Up to you
 
I assume it would be safer/better on her body to have high BG than to become hypoglycemic while I'm asleep. I have enough trouble sleeping from anxiety as it is, and I know I wouldn't be able to go to bed with a good mind worrying about her dipping under 50 in the night.

Is it normal for cats numbers to start dipping back down again at like +10, +11?
 
Also re: testing - you don't need to test so much or stay up so late ;) it looks like you're getting the hang of it though.

She almost always starts with a big drop to +2, then is pretty flat and nadirs around +4. Once you see her flattening out, you can stop testing (or spread the tests out further).

Some examples: today, I would have stopped testing completely after +4. Extra tests certainly don't hurt anything, but don't feel you need to always be checking. A +11 is helpful if you're around just to see what she's doing going into PMPS, but so far she's been pretty predictable, no late nadirs. Last night I probably would have stopped testing after the 108.
 
keykey said:
I assume it would be safer/better on her body to have high BG than to become hypoglycemic while I'm asleep. I have enough trouble sleeping from anxiety as it is, and I know I wouldn't be able to go to bed with a good mind worrying about her dipping under 50 in the night.

Is it normal for cats numbers to start dipping back down again at like +10, +11?
Click to expand...
Absolutely, it's whatever works for you.

Yes, there's a few things. Lantus is occasionally known for a "double dip" in some cats; it's not a second nadir. That said, she's so well regulated it could just be meter variance, or the effect of fasting.
 
Yeah, now that I've got some data of my own to look at, I'm hoping it will build a bit more confidence with how I am going forward. I think I will skip tonight, because those big drops at +2 are usually at least 40 to 50 points, and that would have me dancing right at hypo, right at the latest I would need to go to bed. On top of that, for whatever reason, she's being super picky and not wanting to eat a whole lot right now. Both of those factors make me want to skip tonight.

Question: How would I go about changing her schedule? Would this be a good opportunity tonight to do so, since I'm skipping tonight? Give her shot earlier tomorrow morning than I usually would, that way I can start giving it to her earlier in the evening as well?
 
keykey said:
Yeah, now that I've got some data of my own to look at, I'm hoping it will build a bit more confidence with how I am going forward. I think I will skip tonight, because those big drops at +2 are usually at least 40 to 50 points, and that would have me dancing right at hypo, right at the latest I would need to go to bed. On top of that, for whatever reason, she's being super picky and not wanting to eat a whole lot right now. Both of those factors make me want to skip tonight.

Question: How would I go about changing her schedule? Would this be a good opportunity tonight to do so, since I'm skipping tonight? Give her shot earlier tomorrow morning than I usually would, that way I can start giving it to her earlier in the evening as well?
Click to expand...
Yep, perfect opportunity to shift shot time to where you want it.
 
You must log in or register to reply here.
Back
Top