5/27 :Dealing with nadirs that never occur at the same time

[kimouette]

Hi everyone,

As you might know, I am helping a person living in Paris to deal with her cat's diabetes. If you look at his spreadsheet (the link is in my signature), you will notice that the cat is pretty unstable in terms of nadirs. He eats many little meals (low carb food), we held the initial dose for 14 cycles.. but still, his nadirs keep appearing at random times of the day. Poor Sylvie was hoping she could at least know around what time of the day to test, but it seems like her kitty is going to require a lot more attention than we though.

This morning we increased the dose for the first time (since we started Lantus on May 20th), and it seems like this is one of these days where he gets a really late nadir! She will be testing the +10 in an hour so we'll have more information, but I'm trying to anticipate here what might, and probably will, happen tonight or during the next days...
The protocol says :

when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

But does the same rule apply when you cat has his nadirs at +9, +10 or +11 ?
I mean, is it safe to consider that we are talking about a nadir and not a preshot, and stay with the same dosage (cuz logically the next shot should start working later anyway), or are we taking a huge risk here?

I am always puzzled because of this cat's nadirs happening anywhere between +3 and +11, he even had a sort of inactive cycle yesterday. I do know that I want to see more blue and green values, but his profile never really fits into the protocol's rules so often I'm just confused!

Any advise would be greatly appreciated! Either about tonight's injection or "how to deal with a cat with random nadirs"
Thanks for your help!
Kim, Sylvie, and Kabaret (that's the cat's name)
cat_pet_icon

 

[Wendy&Neko]

Re: 5/27 ealing with nadirs that never occur at the same t

I can sympathize on the random nadirs. I recorded Neko's nadirs at anywhere from +3 to +13 when she was on Lantus. Over time I could spot some patterns that helped my figure out when the nadir was likely to be. If she started high and her +3 or +4 was higher or higher, her nadir would be later. If she started lower and the early +2 was lower then the nadir would be earlier. I was quite fond of the +9 or +10 test because it would give me an idea of whether she was still sliding down or done for that cycle. Bounce breaking cycles had a different behaviour. For the first while Sylvie will have to gather data to see if she can spot patterns that work for Kabaret. She doesn't do much testing late at night, but if she see's a big drop from PMPS to +3, I'd recommend occasionally setting an alarm and getting a middle of the cycle test.

To answer the question about the protocol rule, it doesn't matter when the nadir lands. What's important is how low the dose takes the blood sugar. Since Sylvie saw a nadir under 100 today, she should hold the dose for at least 10 more cycles, unless Kabaret goes under 50.

 

[julie & punkin (ga)]

Re: 5/27 ealing with nadirs that never occur at the same t

wendy said it all!

the only thing i would add is that if she can gradually get comfortable shooting lower numbers, Kabaret's cycles could really flatten out and lower the entire range. Take a look at the "Shooting and Handling Low Numbers" sticky about becoming data ready to shoot lower and see what the gaps in Kabaret's spreadsheet are that need data. Shooting a low number completely changes the game. I'm looking at the 92 tonight that she skipped. i think skipping was fine in this case, but in general, getting handed a low preshot is like being offered an opportunity to lower & flatten the whole blood sugar range. as it says in the sticky mentioned, once you've gotten enough data to shoot low, most numbers over the 50's are shootable provided the cat can be monitored.

Look at Davidson's spreadsheet around early February to see what happens when Shawna started shooting lower numbers. First the nadirs are green, then the preshots, and pretty soon there are entire cycles of green. When a cat is kept in normal numbers (50-120) the pancreas has the opportunity to heal and begin producing insulin again. When that happens, some cats will work off of insulin and become diet controlled. A newly diagnosed cat (less than 1 year since diagnosis) has the best chances for this, but we've had cats go off even after a couple of years.

If you look at this forum's subject lines, you'll see several other people are shooting low preshot numbers right now as well. Juno, Pixie, hmm, and other names are escaping me, but there are several. Take a look at their spreadsheets to see the transition that happens when they begin shooting lower.

The PDF on the Tight Regulation sticky (about 5 paragraphs down from the top) called "Management of Diabetic Cats Using Long-Lasting Insulins" talks about all of this. If you haven't downloaded and looked at it yet, it's well worth it.