? 6/25 Lily AMPS 445 - bounce?

[Elizabeth20]

Hi

Previous

I've been back at work a lot more and I'm not managing to get the mid-cycle shots I'd like to to know what's going on with Lily. I stayed up with her the other night (I don't know how people do this, I'm in pieces now!) because she was breathing funny, like she was asleep and dreaming. She was heading down I think resolving her bounce, which often makes her go a bit funny, and I tried to help her surf by giving some HC food before I had to get to sleep, . She stabilised at 157 at PM+5 and +6 but if she was resolving a bounce I might have just held it off and she could have carried on down after a couple of hours. I slightly reduced her again on the evidence of the reds following the few recent PM cycle blues for the sake of safety, and I know her depot won't have depleted yet but this AMPS has made me worry that I rushed into that.

You'll see from our latest thread that she's recently had glucose intolerance and I think we had got over that and are having a bit of a run down the doses again now but I'm starting to lose perspective without being able to get as many midcycle reads. I was reducing very gradually because she seems to be sensitive to changes and I may have been rather cautious in reducing after she had a low read just under a week ago. She has thrown me reds the last few mornings which she has usually only done when glucose resistant before. I know I'm short on data the last week or so but I wonder if anyone thinks this could be a very strong bounce response or if it could be something else I need to be looking out for? I'd be surprised if it were intolerance but as I say I've lost perspective a bit. Why would her bounce response suddenly be so much stronger?

She seems OK in herself, purring and eating, grooming and peeing a normal amount, although she was very hungry day before yesterday after a red AMPS and had a firm swollen tummy by the afternoon, but no discomfort when I poked her, so I'm minded to rule out infection. I chucked a worming tablet down her to cover my bases. She got a tick on her the other weekend but no hot patches or itching to be found.

Thanks, as ever grateful to have somewhere to go to ask.

Liz

 

[Katherine&Ruby]

Hi Liz!

With SLGS, it's helpful to do a curve every 7 days to see how a particular dose is working for Lily. Could you test her every two hours for 12 hours on a weekend to see? Without this information it's hard to advise on dosing because we want to see how low the dose is taking Lily, not how high. Also, you should hold doses for 7 days unless she drops under 90 and then decrease in .25 unit increments. Increases should only happen once you've done a curve, and they should also be done in .25 unit increments.

Here's an excerpt from the Dosing Methods sticky for SLGS:

Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

If you're ever in doubt at shot time as to what to do say if you get a number in the low 100s, please post here and we can help you decide if you should shoot or not. Skipping shots will only lead to higher numbers, and any number above 90 is a very safe number for you to shoot if you are able to monitor.

 

[Elizabeth20]

You're absolutely right Katherine. I just worry about catching her at it (dropping low) as she has such a bounce response I never know when she's dropping unless she gives me evidence like when her breathing went funny the other night. I think I had kind of given up on curves as well on the same basis - there's no such thing as a representative day with her. I know I don't necessarily help that by adjusting her dose but we are on a kind of hybrid between TR and SLGS as I think is covered in the previous post - I'll amend my signature and spreadsheet to reflect that. The last time I dropped her by a full 0.25 we ended up in resistance so I tend to reduce slightly instead when we're down to fractions of a unit. I will try to do a curve this weekend and see if I can get any idea of what she's up to.

You're right I should have shot at over 90 week before last. I was just worried she was still heading down after she didn't respond to food, and we were about to leave to travel for 3 hours, but I didn't do her any favours there.

Thank you for coming back to me so quickly.

 

[tiffmaxee]

The mid 100’s are totally safe. You want to see nadirs around 100 actually. With TR reductions are taken if under 50 and we strive to be between 50-80 it 100 as a reference. I’m not sure how you change the dose from .80 to .75 and not sure it really constitutes much more if any dose change even if using calipers. Know it’s scary to see lower numbers than used to though.
One suggestion to relieve your stress would be to get some +2-3 tests. Since that’s when lantus onsets , if it’s much lower than the pretest, a later test is a good idea to try and catch the nadir. Also when in the 150’s mc would have been fine.