5/7 Apache amps 61, staggering at +1.5. Pmps dosing?

This morning Apaches numbers were 61 +12. I gave a snack and waited and hour. She was 71 +13. Fed usual and gave usual 1 unit shot. At+1.5 she walked by staggering. I didn't bother to Meter. I just gave some honey on gums and fed her 1/2 can ( can is 3oz). Her numbers after eating were 85. Then 15 min later 122 and 15min later 242. I assume I'm past the critical stage but was wondering if I give usual insulin dose in pm shot?

 

Hi Ric, Oh that’s so scary. I hope she’s doing ok. I would think you’d want to know where she is at pmps to decide to shoot.

Maybe this want to use the question mark in that header to get some attention on dosing.
Wishing you good luck and safe surfing for Apache

 

Numbers under 68 on a pet meter warrant a reduction. Getting 49 on a pet meter as you did a few days ago is too low. She’s been telling you quite clearly that 1u is too much.

 

I do not use a pet meter anymore

 

And yes, I see, a bit confusing since your SS has the header for pet meter and associated BG ranges and colour coding. Just another observation, you want to be careful when you delay a shot for an hour or more, since the next cycle’s shot if given at usual time will actually be at 11 hours (or less) from last shot, and could end up acting like an increase. Her numbers were on the rise after AMPS, and above 50 which would be considered safe. Has she had any previous incidences of staggering? Seems odd and not something expected given the BG tests you had this morning. You’ve noted custom dosing on your SS, is that for a particular reason, ie, when you are taking reductions or increasing dose that isn’t what one would usually follow with TR? If it isn’t tied to when you take reductions, then it would seem that 1u would be the PM dose.

 

When I give a late shot the next shot is 12 hrs from that . I don't short the 12 hr span so there is no increased dose. I don't follow tr regulations because when I do and have to decrease dose ,,, I wind up in the yellow and wind up back at 1 unit to get blue/ green again. Her staggering has never happened and she was sprinting and climbing towers after other cats which was unusual so I took the staggering as hypo signs. Better safe than sorry

Also my ss says I went to a human meter from pet meter.

 

After a decrease, how many 12-hour cycles does she stay in yellow before you increase?

 

Wondering if the staggering could be blood pressure related?

 

If you look at her chart beginning feb you'll see I went to 1 unit and alot if green and blue. If you look b4 that the dose is 1s which is really about .75 .....there is alot of yellow.

It's possible it wasn't hypo but with her strange actions b4 the staggering I was afraid she might be low so better safe than sorry. Right after I gave honey and fed her....she regained her balance.

 

Always better to err on the side of caution when dealing with a possible hypo.

So what are you using as your reduction number? (The BG where if you see anything below that number, you reduce the dose). Is it 50? 60?

I’m relieved to see you’re using a human meter; those lime BG numbers on a pet meter would be very worrisome. It would be helpful if the color formulas in the spreadsheet were adjusted to align with a human meter; if you want someone to do it for you, I know @Bandit's Mom could do it in a jiffy.

As for your dosing—and I mean this with complete respect—I think you might be making life harder than you need to, for both you and Apache.

Apache dropped below 50 so if you’re generally following TR, it would be appropriate to drop to 0.75u and ride that out for awhile. The reason I say “ride that out” is because after dropping into lime green numbers (or dropping fast, or dropping lower than they’re used to), a cat’s system will often react by dumping counter regulatory hormones and something akin to “sugar” into the system to protect him from low numbers, and the fallout from that can be higher numbers (also called a “bounce” around here) that can last up to three days or so. I was asking how long you waited to increase dose because if you don’t wait out at least the 3 days, you can end up misinterpreting the higher numbers as being a result of the reduced dose when it’s not, so then one increases dose again and ends up in a loop…

It also seems you might be (or had in the past) dosed based on the PS number—a little more insulin if the PS is higher, a little less if it’s lower. That almost never works with Lantus. I know because not only have we seen it over and over around here, in my early days using Lantus many many years ago, my instinct was the same. But Lantus is not an “in and out” insulin. It’s a depot insulin, so what you do today can impact tomorrow and beyond, and likewise what you did yesterday can impact today. It’s a bit of a dance. I liken it to adding oil to a car…you add a bit more (i.e., increase insulin dose) then wait for the oil to settle before adding more again. In this case, Lantus takes several days to “settle” and to show you whether a reduction has failed and you need to increase dose again.

After low numbers or a hypo, I’d almost be surprised if the BG didn’t spike higher for awhile, maybe a few days. Again, that’s the body’s defenses and might have less to do with the reduced dose and more to do with the body’s reaction to low numbers.

You’ve been doing a good job with Apache, but I think maybe we can help you do even better. I’ve been following you since you joined and I know you’re very dedicated to Apache. We’re here for you if you’re willing. Feline Diabetes is sometimes a team sport, and we all help each other.

 

First. I thought the color code i have was for a human meter. If not I would appreciate the correction.

Second if you look I was struggling with the .75 dose. If you look and see almost a week of yellow. Ever since I went to 1 unit I've been dialed in pretty good and I have given up on the dose based on the ps number. I've been on 1 unit for quite a while. When her ps numbers are low ( usually 90 or lower)i feed 1/4 can, wait half hour, then feed the rest(half can) and shoot 1 unit. If its lower than 70, i wait an hour to feed the half can and shoot. Ive been getting good results with that keeping her in the blue. I will try the. 75 again. Thank you for keeping an eye out for Apache and myself. Any help as to ways that may improve Apaches numbers are greatly appreciated. All I know is when I went to 1 unit I have alot of beautiful blue / green.

 

For a human meter the normal range (dark green) is 50-100 and below 50 is lime green. For a peter meter, the normal range (dark green) is 68-100 and below 68 is lime green

I can make the changes to your SS, if you'd like.

 

That would be awesome. I started using a human meter on 3/28/23.

 

153+3 . Back in the blue. No bounce so maybe it wasn't a hypo episode. ????? I'll be keeping a close eye on Apache incase this is something else.

 

Done!

 

Thank you ! A couple of 49 's ( one point off 50) and a 33 in lime ( that's kinda worried) but all in all in the green and blue at 1 unit for months now. Seems that's the best I'm gonna get the dose dialed in. Just got into trouble with that 33 but just once and as you can see she still pops up in the yellow once in a while with the 1 unit. A decrease to .75 and im worried she's yellow/ pink

 

Reduced dose to 1slim (basically
.75)Today amps 98, 71+1.5,118+3,pmps208. Did notice something different,,,,She usually gets her nadir at+3. Seems like it's dropping at +1.5 recently which would correspond with the time of her staggering , suspected hypo

Well see how the numbers turn out. Her numbers returned right in the blue/green .....so no bounce

 

I thought with TR it's if they drop below 40 except for newly diagnosed then it's below 50. Unless this is a "know thy cat" situation.

 

Correct Heather. Long term diabetes, with Apache is, have one of three ways to earn a reduction. The first is a week in solid green. Second is a drop below 40. If the cat does not hold reductions well, then a third method can be used - which is to drop between 40 and 49 three times on different days. Note, in this last case a drop below 40 also earns a reduction.

However, following TR means getting a second test every cycle, and that's not happening with this cat. A full 0.25 unit reduction should be taken. What a cat did on a dose in February is way too long ago to consider. She's telling you now that 1 unit is too much.

 

And this means they have to have at least one number in green at both am & pm cycles for 14 cycles?

 

It means no numbers above 100 for a week.

 

Ok, thank you for the info... trying to absorb as much as I can.