5/6/2012 AMPS 240 PMPS 44, Really confused

[Luckyducky]

Hello everyone! I finished another curve for Lucky's week-long dosage at 1.5u bid, and I've been thrown for a loop by some unexpected numbers. On the day of the curve (two days ago) his numbers hovered around the 300's almost all day, which seemed odd since a lot of his recent spot checks were much lower. I decided to keep doing some spot-checks the following day (yesterday), and found to my surprise that his numbers had suddenly swung the complete opposite direction and were extremely low, going as low as 44! :shock: I decided to skip his evening shot as a result, and it seems his numbers jumped right back up. Here are his numbers, and the link to his spreadsheet.

5/5/2012 Curve
AMPS 289
+2 325
+4 307
+6 299
+8 307 (fed a dental treat)
+10 376
PMPS 328
+2 381
+4 381
+6 332
+8 342
+10 267

5/6/2012 Extra Checks
AMPS 240
+3 142
+5 91
+6 73
+7 80
+8 77
+10 71
PMPS 44 (Skipped his shot here, fed a dental treat)
+1 157
+3 292
+6 404

5/7/2012
AMPS 382
+4 368

It's strange that his numbers stayed high in the 300's on the day of the curve, but then suddenly dropped so low the day after. Could it be his shots just didn't take at first? Or, could this be a sign of rebounding, or spotty absorption? (I think I read somewhere that that can happen.) On the day of the curve I also gave him 2/3 of a dental treat (C.E.T. Enzymatic Oral Hygiene Chews Poultry-Flavored) since I'm brushing Lucky's teeth every day now too, and wondered if the treat might have caused his numbers to linger high. I gave him 1/3 of a dental treat yesterday after the low 44, and +6 hours later he was reading 404 --- could that possibly be it as well?

To be honest I'm kinda confused by the swings in his numbers, and uncertain what to do about his dosage given these readings. It's also the second time I've skipped a dose because of low afternoon readings (the last time was on 4/29/12), so I'm concerned his dose might be too high. I was thinking of staying with the 1.5u bid for now and seeing what happens, but was really hoping to hear everyone's opinions before making any decisions.

I can't thank you all enough again for all your help, it's greatly appreciated. :smile: Thanks again, and hope you're all doing well.

 

[Sienne and Gabby (GA)]

One thing to always keep in mind regarding dose is to take a look at the sticky on the Tight Regulation protocol if you're not sure what to do. A drop below 50 is a signal for a dose reduction. You can reduce Lucky's dose to 1.25u. In fact, you could have reduced the dose at your PMPS yesterday. I think your decision to not shoot the 44 was good. There are only a few instances where shooting a number in the 40s is OK. What I would have suggested, though, is that you stall your shot last night and re-test in 20 - 30 min. Given that your +1 was clearly rising, it would have been fine for you to have shot the 1.25u.

Remember, if you get a low pre-shot, Libby's post on handling low pre-shots is available to guide you if no one is around to lend a hand. In brief, if your pre-shot is lower than what you're comfortable with, your options are:

• skip
• shoot a reduced dose - with numbers in the 40s, this usually isn't an option
• stall -- do not feed and then retest 20 min. or so later

From what I read about the ingredients, there's nothing in the dental chews that should cause a rise in numbers. What I believe you're seeing in a bounce. Lucky has not spent much time in green numbers. As a result, his body isn't used to being in that range and his liver overreacted. When this occurs, the liver releases a stored form of glucose along with counterregulatory hormones. These compounds cause a spike in BG numbers. It's one of the body's protective mechanisms. The more time that Lucky spends in lower numbers, the less bouncing you will see. Also, it can take up to 72 hours for a bounce to clear.

 

[julie & punkin (ga)]

hi joe!

just looked at lucky's spreadsheet. i see his pmps tonight was 249 and his +2 was 143. the +2 is a great barometer for telling you what is coming in the next few hours.

if the +2 is about the same as the preshot, that signals that it is likely to bel be a fairly uneventful cycle.
if the +2 is a lot higher, the likely means that a bounce is starting.
if the +2 is lower than the preshot, which lucky's is tonight, that usually means you have to be extra attentive and get some tests in because lucky's going to go lower than usual.

i don't know what time your evening shot was or if you will see this, but if so, please get some additional tests in tonight to catch lucky if he gets below 50.

Here's a post that guides you if you see numbers under 50. http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

btw, you're doing a great job of getting mid-cycle tests in. they really fill out the picture and help us know what's going on.

 

[Luckyducky]

@Sienne: Thanks so much for the fast and thorough reply Sienne, it's much appreciated. :smile: I read your advice last night and I dropped the dose to 1.25u for yesterday evening's and this morning's shot, so hopefully Lucky won't drop so low again during these upcoming cycles. Now that I think about it, those high numbers on the day of the curve do make sense if Lucky was going through a rebound. I guess I was thrown off a bit, thinking he had gotten accustomed to the 1.5u dose already.

One thing that makes me wonder about reducing the dose back to 1.25u, though, is that the last time he was at 1.25u his numbers were mostly high, in the upper 200's and lower 300's. But then, when I increased to 1.5u, suddenly his numbers dropped way down into the 40-100 range. Is that kind of response to a small dose increase normal? I've read that even a little bit of a dose change can make a significant difference, but I didn't think it could be so drastic. I wonder, should I try to aim my dose somewhere between 1.25u and 1.5u? I've noticed some spreadsheets that show fat/skinny for some of the dose numbers, and I guessed that it might be a way to approximate slightly higher/lower shot values(?). Could something like that be appropriate for Lucky, since so far he's seen progress at 1.5u, but not so much at 1.25u?

I'm definitely going to sit down and read through all the Stickies now too... I've looked through them before, especially in emergency situations, but I think I might have missed some important parts, and I think I'm even forgetting parts I already read .

@Julie: And thanks so much Julie for your insight too, I was going to do exactly like you suggested and get some more readings in, but unfortunately I missed my opportunity last night (I was so exhausted I accidentally fell asleep ). I'm guessing Lucky must have dipped pretty low and had a bounce after the shot last night, since his numbers jumped up surprisingly high this morning. I'm going to try and be more diligent once his numbers start dropping low again, so thank you very much for the information on the +2 reading predictions, it'll definitely help me better gauge when I really need to do more readings and keep an eye out.

Thanks again everyone for the advice and information, and I'll be sure to update this post if anything else comes up. :smile:

 

[julie & punkin (ga)]

you know, there is so much to learn - even people who've been doing this a year can pick up new things from reading the stickies. i found that until something applied to punkin, it didn't really stick in my brain. don't worry about not getting all of it yet, we're all like that!

yes, a tiny change in dose can make a big difference in numbers. just keep posting and we'll help you interpret if you're seeing a bounce or what.

 

[Libby and Lucy]

the +2 is a great barometer for telling you what is coming in the next few hours.

if the +2 is about the same as the preshot, that signals that it is likely to bel be a fairly uneventful cycle.
if the +2 is a lot higher, the likely means that a bounce is starting.
if the +2 is lower than the preshot, which lucky's is tonight, that usually means you have to be extra attentive and get some tests in because lucky's going to go lower than usual.

Quick point of clarification -

If +2 is much lower than preshot, then you definitely need to pay attention. If +2 is much higher than preshot (in a cat with onset of +2 to +3) then you might be seeing the beginning of a bounce and might have an easy cycle. If +2 is about the same as preshot, then you can usually expect a descent into nadir. It might be a fast descent or it might be a slow descent (or, because we are dealing with cats, they might surf or they might turn around and go back up).

in a "typical" Lantus curve (with a cat that has onset between +2 and +3) a +2 that is the about the same as preshot means that the numbers will probably be going down. You just don't know how far or how fast - this is a good reason to get a +3 or +4. :smile: In most cats on Lantus, +2 is about when the insulin starts working.