max&emmasmommie
Member Since 2012
I don't know what to think. So, I'm having positive thoughts. Maybe the shed filled up all at once or the relief from the constipation was sudden. Who knows? If anyone has any ideas, please let me know. Thanks.
5/26/12 Max PMPS last night 600+ AMPS 227 ??
- Thread starter max&emmasmommie
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Dale:
I'm responding to your post in the TR forum.
Without some idea of what's happening at mid-cycle, you are asking us to use a crystal ball to figure out why Max's numbers are what they are. He occasionally throws you a low pre-shot number. I have no doubt that he's dropping into lower numbers mid-cycle and bouncing.
I don't think this dose is working. However, I do not feel comfortable making any suggestions about changing your dose. Lantus dosing is based on the nadir, not on pre-shot numbers. Please do your best to get at least one spot check during both the AM and PM cycles.
I'm responding to your post in the TR forum.
Without some idea of what's happening at mid-cycle, you are asking us to use a crystal ball to figure out why Max's numbers are what they are. He occasionally throws you a low pre-shot number. I have no doubt that he's dropping into lower numbers mid-cycle and bouncing.
I don't think this dose is working. However, I do not feel comfortable making any suggestions about changing your dose. Lantus dosing is based on the nadir, not on pre-shot numbers. Please do your best to get at least one spot check during both the AM and PM cycles.
max&emmasmommie
Member Since 2012
I used Miralax to clear the constipation
No, I wouldn't change the dose without mid-cycle numbers just because he had this ridiculously high reading out of the blue. But it was very strange to be that high and then at 227 just 12 hours later. I thought that if someone had seen this happen to his/her cat, and then ended up in ER with some kind of issue--like a liver issue or something, I'd like to know about it.
No, I wouldn't change the dose without mid-cycle numbers just because he had this ridiculously high reading out of the blue. But it was very strange to be that high and then at 227 just 12 hours later. I thought that if someone had seen this happen to his/her cat, and then ended up in ER with some kind of issue--like a liver issue or something, I'd like to know about it.
Pumbaa
Member Since 2012
Dale, even though I test Pumbaa at all different hours of the day, because he hasn't shown his true nadir yet, you need to do more BG testing.
I looked at your SS and there just isn't enough data for anyone here to be able to help you, because they can't see how your kitty responds to the insulin over a cycle or a 24 hour period.
If you can't test regularly during the week due to work hours, at least take one day every weekend to test every two hours and see how your kitty is reacting to the insulin. And be religious about putting those numbers in your SS, as that is what everyone looks at when you have questions about dosing or potential medical problems that need to be addressed.
Suze
I looked at your SS and there just isn't enough data for anyone here to be able to help you, because they can't see how your kitty responds to the insulin over a cycle or a 24 hour period.
If you can't test regularly during the week due to work hours, at least take one day every weekend to test every two hours and see how your kitty is reacting to the insulin. And be religious about putting those numbers in your SS, as that is what everyone looks at when you have questions about dosing or potential medical problems that need to be addressed.
Suze
max&emmasmommie
Member Since 2012
Suze, thanks, and thanks for being politic. No, he hasn't shown his nadir yet, and I can't find it because he is constantly bouncing.
Sienne, I suppose everyone assumes that the question is should I change the dose"for every post. It's not. Sometimes, some of just need some support. I suppose people who don't have bouncy cats don't understand. Sometimes we are just worried that there is something we are missing. We live in constant fear that we'll be making that final trip to the vet any day now because we can't get our cat's BG under control.
I have one year old child, and it is very, very hard for me to test Max frequently, but on May 8 I did a full curve. He was doing great until the last test at PMPS. I thought I had found that I was close to the dose, and that I was going to find out that he needed 3 units. Then everything went to heck as it always does after he has one good number. It is so frustrating. So, I waited for the bounce to clear.
When he is bouncing, it seems that there is no point in making it so that nearly all the time I have to spend with him becomes me stabbing him with a lancet or a needle or an even bigger needle for subcu fluids. I really do see his attitude change when I have to do a curve. He tenses when he sees me coming. He starts to wonder, I'm sure, why all I do is stab him, but I don't have time for much else when I'm doing a curve. I can't use a curve that I get when he's bouncing to change the dose anyway.
That time the bounce lasted 72 hours. Then, he had another bounce after a good number on May 12. Seventy-two more hours and another good number and another bounce! This time, it just got worse and worse. I suppose he was constipated, and that is why it seemed that the bounce never cleared. I was hoping that he would show me that we were close to the dose by clearing the bounce more quickly. I guess that's was not to be. Then, the baby started teething, and I got sick, and here we are.
Maybe I should just start over at 1 unit. I always felt that was going to leave him in the 500 and 600 too long, and I wanted to avoid that, but now, months later, he's been in the 400s a lot, and it might have been a waste. I just afraid that I'm going to find out he needed 3 or 3.5 units, and I'm almost there as it is. It seems to me that if giving him 2.75 was way too much he would have had a few hypo incidents by now. I've been giving it to him since April 27. The counter to that is that on May 6, his AMPS was so low that I had to give him a very small dose.
I'll do a curve, and then, I'll ask if anyone thinks I should start over at one unit. Unless, of course, anyone feels comfortable chiming in on that subject without a recent mid-cycle. He's going to bounce for the next 2 days after that 227.
Sienne, I suppose everyone assumes that the question is should I change the dose"for every post. It's not. Sometimes, some of just need some support. I suppose people who don't have bouncy cats don't understand. Sometimes we are just worried that there is something we are missing. We live in constant fear that we'll be making that final trip to the vet any day now because we can't get our cat's BG under control.
I have one year old child, and it is very, very hard for me to test Max frequently, but on May 8 I did a full curve. He was doing great until the last test at PMPS. I thought I had found that I was close to the dose, and that I was going to find out that he needed 3 units. Then everything went to heck as it always does after he has one good number. It is so frustrating. So, I waited for the bounce to clear.
When he is bouncing, it seems that there is no point in making it so that nearly all the time I have to spend with him becomes me stabbing him with a lancet or a needle or an even bigger needle for subcu fluids. I really do see his attitude change when I have to do a curve. He tenses when he sees me coming. He starts to wonder, I'm sure, why all I do is stab him, but I don't have time for much else when I'm doing a curve. I can't use a curve that I get when he's bouncing to change the dose anyway.
That time the bounce lasted 72 hours. Then, he had another bounce after a good number on May 12. Seventy-two more hours and another good number and another bounce! This time, it just got worse and worse. I suppose he was constipated, and that is why it seemed that the bounce never cleared. I was hoping that he would show me that we were close to the dose by clearing the bounce more quickly. I guess that's was not to be. Then, the baby started teething, and I got sick, and here we are.
Maybe I should just start over at 1 unit. I always felt that was going to leave him in the 500 and 600 too long, and I wanted to avoid that, but now, months later, he's been in the 400s a lot, and it might have been a waste. I just afraid that I'm going to find out he needed 3 or 3.5 units, and I'm almost there as it is. It seems to me that if giving him 2.75 was way too much he would have had a few hypo incidents by now. I've been giving it to him since April 27. The counter to that is that on May 6, his AMPS was so low that I had to give him a very small dose.
I'll do a curve, and then, I'll ask if anyone thinks I should start over at one unit. Unless, of course, anyone feels comfortable chiming in on that subject without a recent mid-cycle. He's going to bounce for the next 2 days after that 227.
Pumbaa
Member Since 2012
Dale:
It sounds like you've been doing more testing but just haven't put the numbers in the SS due to having your hands full with a baby that's teething, etc. What helps me is having a dry erase board on my fridge (I test in the kitchen), where I record all of Pumbaa's numbers for the day, and then enter them when I have time.
Also, during testing, what helps me when Pumbaa is fidgety or not wanting to be pricked, is to give him some low-carb high quality treats. That distracts him while I'm testing. Usually, I give him smooshed up sardines (packed in water, no salt), but Max might have a different treat that he would find irresistible (some hamburger...some cooked chicken, whatever). Our testing position is Pumbaa's butt on my lap and his front paws on the table in front of me. That way I have everything I need right in front of me, and can put the treats in front of his face while I test.
I feel for you being frustrated by the dosing and the bounces, I truly do. Pumbaa is a big bouncer, too, and I'm really tired of seeing black and red numbers on his SS. *sigh*
Suze
It sounds like you've been doing more testing but just haven't put the numbers in the SS due to having your hands full with a baby that's teething, etc. What helps me is having a dry erase board on my fridge (I test in the kitchen), where I record all of Pumbaa's numbers for the day, and then enter them when I have time.
Also, during testing, what helps me when Pumbaa is fidgety or not wanting to be pricked, is to give him some low-carb high quality treats. That distracts him while I'm testing. Usually, I give him smooshed up sardines (packed in water, no salt), but Max might have a different treat that he would find irresistible (some hamburger...some cooked chicken, whatever). Our testing position is Pumbaa's butt on my lap and his front paws on the table in front of me. That way I have everything I need right in front of me, and can put the treats in front of his face while I test.
I feel for you being frustrated by the dosing and the bounces, I truly do. Pumbaa is a big bouncer, too, and I'm really tired of seeing black and red numbers on his SS. *sigh*
Suze
max&emmasmommie
Member Since 2012
Thank you, Suze. I'll try that treat trick. Maybe he'll be less worried. I used to give him bits of lard each time I tested, but that got too complicated with getting it out of the fridge, trying to keep from contaminating the whole package, cleaning up, etc.
I do like that dry erase board idea.
I really don't understand bouncing except that the low BG causes the liver to dump glucose into the system; it can last up to 72 hours; and the bounces clear faster when you get closer to the correct dose. Beyond that, I have no idea, and there isn't much information about it. I've even read that it's controversial.
I haven't been testing more than what you see on the spreadsheet. I don't see the point when he's bouncing. I have no info on how bouncing should be factored in when deciding when to run curves. What I think is common sense is that scores while bouncing mean nothing to deciding in a change in dose except that you might drop to 0.5 or 1 unit and start over. I don't feel that a nadir when he's bouncing tells me anything about how the insulin is affecting his system. What is going on when the liver is not dumping extra glucose randomly and in random amounts would be very helpful, I just can't get that information. Maybe I'm wrong, but I can't find anything that tells me differently.
I've been waiting and waiting for a chance to get a good curve that tells me something. So, I just feel frustrated. It has been pointed out to me that looking back when the dose was under 2 units the numbers were almost always in the red and black category. The higher the dose, the more chance of purple numbers, and even yellows and blues. So, that could mean that he really does need the higher doses? I guess I'll just do a curve regardless of the "bouncing," and try to use the numbers for something. After all the alternative is the keeping going along like I have been, and that's getting me nowhere.
I do like that dry erase board idea.
I really don't understand bouncing except that the low BG causes the liver to dump glucose into the system; it can last up to 72 hours; and the bounces clear faster when you get closer to the correct dose. Beyond that, I have no idea, and there isn't much information about it. I've even read that it's controversial.
I haven't been testing more than what you see on the spreadsheet. I don't see the point when he's bouncing. I have no info on how bouncing should be factored in when deciding when to run curves. What I think is common sense is that scores while bouncing mean nothing to deciding in a change in dose except that you might drop to 0.5 or 1 unit and start over. I don't feel that a nadir when he's bouncing tells me anything about how the insulin is affecting his system. What is going on when the liver is not dumping extra glucose randomly and in random amounts would be very helpful, I just can't get that information. Maybe I'm wrong, but I can't find anything that tells me differently.
I've been waiting and waiting for a chance to get a good curve that tells me something. So, I just feel frustrated. It has been pointed out to me that looking back when the dose was under 2 units the numbers were almost always in the red and black category. The higher the dose, the more chance of purple numbers, and even yellows and blues. So, that could mean that he really does need the higher doses? I guess I'll just do a curve regardless of the "bouncing," and try to use the numbers for something. After all the alternative is the keeping going along like I have been, and that's getting me nowhere.
Pumbaa
Member Since 2012
Max had a beautiful morning cycle on 3/19 with all greens and blues, but then you did a dose decrease (probably based on the 51 reading) and he kinda went to hell after that, what with constant bounces and lack of testing data, etc.
Here's what I think, and what I would do if this was my Pumbaa. And trust me, I am NO expert at this. So, since this is free advice, use at your own risk!
I would drop him down to 1.75U (or lower...maybe back to 1.0U?), and wait 72 hours for the shed to deplete before taking lots of new readings and trying to figure out his numbers. Then, depending on his numbers after his shed has depleted, I would decide on dose increases or decreases. But do take time to let him settle in to the new lower dose. And start testing more regularly. Pumbaa needs a long time to settle into a dose. When I see him flatten out, and clear all bounces, I know it's time for a dose increase (or decrease). ECID: Every cat is different! Your Max and my Pumbaa are not poster cats for the tight regulation protocol, that is for sure!
Don't forget, if you miss a dose, or think you gave a fur shot, you start over analyzing the BG numbers at the start of the next cycle.
Do get the magnetic dry erase board to record the numbers, it will simplify your life! And do start bribing Max during testing time. Pumbaa now purrs on my lap during testing time, even though he seldom gets his sardine treats anymore. This is only because I made testing time a ritual/positive experience (with bribes), from the very beginning.
Oh, you don't want to run a curve during a bounce or new-dose-wonkiness. That is difficult when our cats react differently all the time, that is for sure! Once I thought I had Pumbaa figured out (he had his lowest numbers 4 cycles after a dose increase) he proved me wrong and threw me a huge wrench by dropping down into the greens in the first cycle after a dose increase! They sure keep us on our toes, don't they?
Suze
Here's what I think, and what I would do if this was my Pumbaa. And trust me, I am NO expert at this. So, since this is free advice, use at your own risk!
I would drop him down to 1.75U (or lower...maybe back to 1.0U?), and wait 72 hours for the shed to deplete before taking lots of new readings and trying to figure out his numbers. Then, depending on his numbers after his shed has depleted, I would decide on dose increases or decreases. But do take time to let him settle in to the new lower dose. And start testing more regularly. Pumbaa needs a long time to settle into a dose. When I see him flatten out, and clear all bounces, I know it's time for a dose increase (or decrease). ECID: Every cat is different! Your Max and my Pumbaa are not poster cats for the tight regulation protocol, that is for sure!
Don't forget, if you miss a dose, or think you gave a fur shot, you start over analyzing the BG numbers at the start of the next cycle.
Do get the magnetic dry erase board to record the numbers, it will simplify your life! And do start bribing Max during testing time. Pumbaa now purrs on my lap during testing time, even though he seldom gets his sardine treats anymore. This is only because I made testing time a ritual/positive experience (with bribes), from the very beginning.
Oh, you don't want to run a curve during a bounce or new-dose-wonkiness. That is difficult when our cats react differently all the time, that is for sure! Once I thought I had Pumbaa figured out (he had his lowest numbers 4 cycles after a dose increase) he proved me wrong and threw me a huge wrench by dropping down into the greens in the first cycle after a dose increase! They sure keep us on our toes, don't they?
Suze
max&emmasmommie
Member Since 2012
Well, we are in for another screwed up situation for sure -- +6 was 95 and PMPS was 140. So, I gave him 0.5 units. Sigh . . .
Pumbaa
Member Since 2012
On the plus side, Max had some beautiful numbers yesterday!
Since I have only had to face a low pre-shot number once so far, this link was recommended to me. I had done the same thing you did...gave a BCS (Big Chicken Shot). *LOL* After reading the information in the link, I could have stalled on the shot and tested Pumbaa in 20 minutes, just to see if the numbers were on the rise or dropping. If they were on the rise, I could have given Pumbaa his regular dose, and then watched him over the next couple of hours.
But, from what I've read, giving some insulin (BCS) is better than just skipping the dose entirely, so you went with your gut and did good. And if you gave him his regular dose this morning, that is where you would start tracking numbers again, at this morning's cycle.
Here's hoping that Max doesn't bounce dramatically, and he has some more beautiful numbers like yesterday!
Suze
Since I have only had to face a low pre-shot number once so far, this link was recommended to me. I had done the same thing you did...gave a BCS (Big Chicken Shot). *LOL* After reading the information in the link, I could have stalled on the shot and tested Pumbaa in 20 minutes, just to see if the numbers were on the rise or dropping. If they were on the rise, I could have given Pumbaa his regular dose, and then watched him over the next couple of hours.
But, from what I've read, giving some insulin (BCS) is better than just skipping the dose entirely, so you went with your gut and did good. And if you gave him his regular dose this morning, that is where you would start tracking numbers again, at this morning's cycle.
Here's hoping that Max doesn't bounce dramatically, and he has some more beautiful numbers like yesterday!
Suze
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