Re: 6/25 Purrcee AMPS 146 45 Min test 138 +13.5 157
Julie
Just a few fun things to learn now that the tense moments are over
We like to suggest a +10/+11 test whenever it is possible because it allows you to know if kitty is dropping going into preshot. Shooting dropping numbers can give you a great ability to take advantage of carryover and overlap of lantus.
Carryover - insulin effects lasting past the insulin's official duration
Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
There could have been two scenarios last night:
1. PMPS 291 and he could have come down to a blue nadir, gone back up a bit, and then gotten a second lantus dip that you saw this morning OR
2. More likely based on how he kept dropping, he was dropping from PMPS all the way to +12; this is indicative of a dropping number usually associated with clearing a bounce (but not always).
A second dip is safe to shoot without stalling because he has already had a nadir, has come up, and is just going to dip a bit before coming back up again. Then he will onset around +2.
A dropping number has to be addressed with a little more caution. When we don't know if it's a dropping number or not, we stall to see if there is a rise.....just like you did today.
Once you have a little more data, you will know whether he is getting a second dip or whether he's dropping and you can shoot more on schedule.
I have to strongly urge you to test a little more. Even when you get a high preshot, please get another test during the cycle whether it is a +2, a mid cycle, a +10/+11, a before bed.....whatever but you are missing the opportunity to know what is going on with Purrcee and better address how to handle it. I've seen cats go from 300 at PS to 40 at midcycle to 300 at the next PS. Without that midcycle test, the caregiver would have thought the cat needed more insulin.
Sienne and I are also big fans of a +2 test. It will potentially tell you alot about that cycle. If the +2 is much higher than the Preshot, it's likely to be a non active cycle with numbers staying flat or rising. If the +2 is similar to or the same as the PS, it's likely to be a normal, active lantus cycle as shown below. If the +2 is much less than the PS, it's likely to be a very active cycle with a possible early drop. That can help you decide when to test next.
Example of a typical Lantus curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
If you get a chance, could you please update the subject line to show his AMPS as 157? To show this all correctly on his SS so we know you stalled, go to the evening +11 column and put "146 @ 12; 138 @ 12.75" Then in the AMPS column, put "157 @ 13.5".
To get back on schedule, you have options:
1. If he zooms up above 300 by +10.5, shoot early and you'll be back on schedule. You MUST monitor especially grab some spot checks tonight and tomorrow because shooting early like that can act as an increase and you might see numbers come down in a subsequent cycle.
2. if he doesn't zoom up, shoot 15 mins early each cycle until you are back at your normal shot time OR you can also shoot 30 mins early once a day starting tomorrow morning until you are back on your normal shot time.
Any questions??? I've thrown alot at you.
