? 6/21 Max - Please tell me it gets better! AMPS in 500s; PMPS 400-500s

[Rebecca & Max (GA)]

It's been a good number of days since I posted last and we have switched between the AT and the Freestyle Libre for BG readings, but now that we are back to ear sticks and the AT (yay, they are getting easier...FINALLY!!). With Max also back up to 0.5U, I had really expected to see his numbers starting to go down again. I still need to take at least one reading consistently between shots, but we're working on that. However, I'm dismayed at seeing so much red & black.

He's on wet food only (aiming for 0-2% Weruva foods and 0% Tiki Cat), and gets fed about 6 times a day (1-2 ounces is about what he wants/eats). He naturally wants food between +4/+5 and again at +9/+9.5 so I'm trying to feed him then both AM & PM (food is cut off over 2 hrs prior to AM/PM reads which are often 11:45-12:00 AM & PM). He had a few hypo incidences while at 2U and then 1U, so he was dropped to 0.5U. Then he bounced and I dropped him to 0.25U and held him there for 6 days (most of the Libra data is from then). It was time to increase him back to 0.5U and that's when the Libra ended (got 11.5 days of data). I know going back to the AT would result in higher readings than the Libre, but am I wrong for believing that his numbers should have dropped at least a little after 6 days at 0.5U?

I'm not sure what else I can do to help Max (aside from increasing his dose, which the vet will probably want on Monday when he calls). Feeding him only 2x a day isn't going to fly with him, but he would probably be okay with only one evening feed, rather than an afternoon and evening meal. The only plus side to our new feeding schedule is that my CKD kitty is eating more consistently too, which is something she really needs.

Thoughts?

 

[Bron and Sheba (GA)]

Are you able to get any tests in during the PM cycle? For the last several days the pm cycle is almost blank. we need to see if Max is dropping lower at night.
When did you change over to the AT meter? can you draw a coloured line in the SS to show us where the changeover occurred please? Is that possible?
If the pm cycle doesn’t show any lower numbers I would increase the dose to 0.75 units.

 

[Rebecca & Max (GA)]

Are you able to get any tests in during the PM cycle? For the last several days the pm cycle is almost blank. we need to see if Max is dropping lower at night.
When did you change over to the AT meter? can you draw a coloured line in the SS to show us where the changeover occurred please? Is that possible?
If the pm cycle doesn’t show any lower numbers I would increase the dose to 0.75 units.

I did put a break in the SS and labeled it as ‘Libre ended’, but will color the boxes too. His PM post times are actually in the middle of the night as he gets his dose around 11:45 PM to 12 AM (due to a 2.5 hr stall I had weeks ago, and decided the times worked better for us). With the Libre I could set an alarm and scan him while he slept, then go right back to sleep. Just haven’t been wanting to wake up and stick him at 5 AM. I can get one around 8:30 AM when he’s ready to eat, as long as I’m not feeding the other cat and medicating dogs at the same time. Trying to do better with that so there’s more data. The vet is supposed to call tomorrow and go over dosing after he looks over the Libre info. I’m sure he’ll say go back to 1U, but I wanted to ask about going to 0.75U first. I just wasn’t sure if there was a time when doubling the dose was ever warranted.

 

[Sienne and Gabby (GA)]

@Bron and Sheba (GA) - the PM tests are late in the cycle the last couple of days.

Bron is right, though. You do need to get at minimum, your pre-shot tests and one additional test each cycle.

In part, the high numbers are due to some bouncing. The 0.25u were clearly not enough insulin and it's looking like the 0.5u dose isn't enough either. Don't base how the same dose that worked 2 - 3 weeks ago will work now. The dosing needs can change. Also, don't presume because the pre-shot number is high that the numbers are high throughout the cycle. My kitty could start out in the 400s, drop to the 40s, and be back in the 400s by PMPS. If I hadn't been testing, I would have increased the dose when a dose reduction was indicated.

 

[Rebecca & Max (GA)]

@Bron and Sheba (GA) - the PM tests are late in the cycle the last couple of days.

Bron is right, though. You do need to get at minimum, your pre-shot tests and one additional test each cycle.

In part, the high numbers are due to some bouncing. The 0.25u were clearly not enough insulin and it's looking like the 0.5u dose isn't enough either. Don't base how the same dose that worked 2 - 3 weeks ago will work now. The dosing needs can change. Also, don't presume because the pre-shot number is high that the numbers are high throughout the cycle. My kitty could start out in the 400s, drop to the 40s, and be back in the 400s by PMPS. If I hadn't been testing, I would have increased the dose when a dose reduction was indicated.

Can AM cycles and PM cycle differ THAT much? If he was dropping that low during the PM cycle, wouldn’t he possibly follow something similar during the AM cycle? I realize that I need at least a second test each cycle, if not more. However, daytime is obviously easier. I can aim for a 6 AM test but he’s usually fed between 4-5 AM, so I’m not sure how accurate that mid-cycle test will be? Would his nadir be affected by the food, in other words? Would it then be better to test him before I fed him in the wee hours? I can’t see him going from a 588 PMPS to 401@+9 to an AMPS at 586 and have dropped as low as yours, but since I’m not testing every few hours, anything is possible. Seeing his numbers yesterday (and yes, I realize it’s ONLY 1 day), made me think he’s staying high, but that’s a dangerous assumption. He was staying very consistent on the Libre, so again, I figured he’s holding steady, but high. Setting alarms to test him a few times again today, and will try to get at least one test in the wee hours tomorrow, if not more. Sadly, I sleep very little as it is, due to other animals with health issues, so I’m doing the best I can. Looks like some extra effort is needed...

 

[Sienne and Gabby (GA)]

Take a look at Gabby's spreadsheet (there's 6.5 yrs of data -- you might want to look at the first. year or so). Numbers can vary widely. Even on Max's SS, on 6/5 he was in blue numbers in the AM and bounced into the 500s that evening. Right now, you don't have a great deal of data so a lot of this is a guessing game. Like I said, if you look at Gabby's SS on 11-2-2009, her AMPS was 429, her +3 was 47, and her PMPS was 400 and she dropped into low 300s when I stopped testing. Her AMPS the following morning was 256 and she kept deciding that I needed to be paying more attention to her. (FYI - Gabby had an early onset and nadir. She also liked to dive -- a lot. She wasn't your typical kitty but her SS can be instructive and I was a testaholic.)

What I generally suggest re. PM tests is to get a +2 or +3 depending on when your cat's typical nadir is. If that early number is substantially less than the pre-shot number, it may be a cycle when you're going to have to test more to make sure numbers aren't dropping. Typically, the number at onset (which for many cats is around +2 or so) should be about the same as your pre-shot number. The food at shot time will raise numbers and they should level out. If the onset number is a lot lower, you'll need to get tests.

I'd also suggest getting a timed feeder. If Max will reliably eat, then you don't have to wake up to feed him.

It looks like. you saw a sizable drop at +3 today. Also, remember to include the amount of the dose. You don't have that column filled in.

 

[Chris & China (GA)]

I can aim for a 6 AM test but he’s usually fed between 4-5 AM, so I’m not sure how accurate that mid-cycle test will be? Would his nadir be affected by the food, in other words?

The Pre-shot tests are the only ones we really want to be non-food influenced. The rest of the time, feed as you normally would.

We want to see what happens on normal days....so if he usually eats at 4-5am, let him eat ...if you shoot at 11pm, you could test at 4, 5, 6, 7am

 

[Chris & China (GA)]

Becky....here's a video somebody made who uses the Libre exclusively. I haven't watched it in awhile, but I remember she has recommendations for glue to use. Don't know if it'll make any difference for Max though.

 

[Rebecca & Max (GA)]

The Pre-shot tests are the only ones we really want to be non-food influenced. The rest of the time, feed as you normally would.

We want to see what happens on normal days....so if he usually eats at 4-5am, let him eat ...if you shoot at 11pm, you could test at 4, 5, 6, 7am

I have been letting him eat normally -except for the 2 hr window before AM & PM PS. I make a note when he’s been fed and with what as I’m trying to see if food is playing a role or not. Sadly, I slept the deepest after his 4-5 am feeding and usually don’t wake up until around 8 which is about the time my elderly dad starts waking up (stay at home mom, and it summer vacation for us too). That’s why I kept having +9 tests. What I might need to do is go to bed around 8 PM and then get up for his PMPS, then go back to bed and get up again for the other tests. I learned when my twins were babies that I don’t do well with an hour or two of sleep at a time...I better off getting 4 hrs of straight sleep rather than an hour or two on and off for 8 hours!

 

[Chris & China (GA)]

Sadly, I slept the deepest after his 4-5 am feeding

If you're already up at 4 or 5am to feed, can you test then? (if he'll let you) That would be 5-6 hours since the shot so would cover a mid-cycle test on the PM cycle