6/27 Lucian AM 54

[nckitties3]

Need some experienced eyes to look at Lucian's SS. He's recently started spiking mid cycle and dropping at pre shot.

I did not shoot this morning @ 54, that was too low for me to be comfortable with, although I shot a 94 yesterday and he spiked to 455 @+8.

I don't understand the mid cycle spike, how can he be at his highest when the insulin should be at it's greatest effect? I remember reading that this could happen if the dose was too high.

His +1 is 101, still have not shot.

Would really appreciate your thoughts on this.

 

[Sienne and Gabby (GA)]

Re: 6/27 Lucian AM 54 Thoughts?

It looks to me like you're getting really good low numbers and then Lucian's liver is panicking and throwing him into a bounce that is clearing quickly. The good news is that he's getting used to those lower numbers so the bounces are working themselves out in a cycle or two and you're seeing the bounce clear around shot time. It seems like this particular pattern started with the 91 on 6/24.

While it may take some additional time to figure this out, another possibility is that Lucian's nadir is shifting to a "late nadir" pattern. Some cats have their nadir close to the end of the cycle. When this happens, the SS looks like everything is shifted by 6 hours -- the highest point in the cycle is in the middle and the low is around shot time.

 

[nckitties3]

Re: 6/27 Lucian AM 54 Thoughts?

If he would do something consistently I'd figure out how to handle it.

Yes, sometimes he nadirs late, just as often, he'll spike late cycle, as though the insulin isn't lasting long enough and I've taken to small doses of R to keep him out of the black.

I'm considering taking him down .25 and see if he'll mellow out a little. He has become even more erratic since the increase. I'm at a loss as to what to do with him.

 

[Anne & Zener GA]

Re: 6/27 Lucian AM 54 Thoughts?

Wow, Lucian does love his trampoline! :shock: Cats can bounce from low numbers and from rapid drops. Could you possibly give him something higher carb when he is dropping rapidly to try to slow it down?
Liz

 

[nckitties3]

Re: 6/27 Lucian AM 54 Thoughts?

Oh Liz, I've been feeding up for weeks. Anything in an attempt to stabilize him from the highs and lows.

Here's what I got:
AMBG 54
+1 101
+2 132 - shot reduction 1.75

Didn't want his schedule even more messed up than it is.

I really am at a loss, going on 7 months now and feel like a newbie.

 

[Sienne and Gabby (GA)]

Re: 6/27 Lucian AM 54 Thoughts?

Debbie --

From what I've seen over the years, decreasing the dose as a means to "fix" the bouncing doesn't work. All it seems to do is put the kitty in high numbers, make glucose toxicity a real issues (which then makes bouncing even more of a headache), and leave you scratching your head even harder. At the moment, Lucian isn't bouncing quite as high.

When are you feeding Lucian (i.e., at what +times). It may be that some food manipulation or some other strategies may help a bit.

 

[nckitties3]

Re: 6/27 Lucian AM 54 Thoughts?

I feed Lucian when he's hungry, he is a VERY vocal cat and will not quit if he wants to eat. He eats every 3-4 hrs, either a snack of 1/8 5.5 oz can or meal of 1/4 can. If he has eaten within 2 hrs of a test, it is on his SS, which is very rarely. I try to make sure his numbers aren't food influenced when I test. If he wants something close to preshot, he gets cooked turkey meat with no carbs.

For today, he got a dose reduced by .25.

 

[Deb & Wink]

Re: 6/27 Lucian AM 54 Thoughts?

Debbie,

I'm confused. Are you still on the Lantus or have you switched to the Levimir?

 

[nckitties3]

Re: 6/27 Lucian AM 54 Thoughts?

No Deb, still Lantus. Yeah, I'm confused too. :?

Taking care of Lucian is a 12 step program - One day at a time.

 

[Deb & Wink]

Re: 6/27 Lucian AM 54 Thoughts?

Just wanted to double check because you had mentioned over in "relaxed" forum that you might be switching.

Good to see you posting here. More eyes to help figure out what is going on.

 

[nckitties3]

Re: 6/27 Lucian AM 54 Thoughts?

I have 2 Lev pens given to me to try, but haven't done so yet. Jill has been trying to keep an eye on him, when she can and asked me to hold off on it.

But today I really needed some experienced eyes to give me their thoughts and ideas about him.

Sometimes he already thinks he's a Lev kitty, with a late nadir. I just don't know what to do with him.

 

[Jill & Alex (GA)]

Re: 6/27 Lucian AM 54 Thoughts?

Have not shot. Something isn't right.

there's nothing wrong. nadirs shift. lucian throws late nadirs every once in awhile. no big deal. it happens and it's not unusual.

I cross posted in TR, need some eyes on this.

good thinking!
again, i'm asking you to continue posting in this group. you need the support and the experience readily available here. this morning, someone could have walked you through/held your hand with shooting low to stay low. this level of help, degree of experience, understanding of the long lasting insulins, and support is generally not available in the relaxed group. you do not have to follow a tight regulation protocol to post here.

imho, you belong in this group. posting in the relaxed group is holding you back.

I shot a reduced dose, back to 1.75, in hopes of him not getting too out of whack.

not sure why you reduced the dose. 2u bid was not taking him too low.

Need some experienced eyes to look at Lucian's SS. He's recently started spiking mid cycle and dropping at pre shot.

I did not shoot this morning @ 54, that was too low for me to be comfortable with, although I shot a 94 yesterday and he spiked to 455 @+8.

I don't understand the mid cycle spike, how can he be at his highest when the insulin should be at it's greatest effect? I remember reading that this could happen if the dose was too high.

His +1 is 101, still have not shot.

Would really appreciate your thoughts on this.

i understand not feeling comfortable shooting a 54... for now. at some point you'll be comfortable shooting over 50 when you're available to monitor. in other words, you want to learn to shoot low to stay low.

at +13 lucian was 101. his BG almost doubled in one hour. not sure why you didn't shoot. his numbers were definitely going up. ;-)

at +14 lucian was already up to 132. what does that tell you? it tells you that he would have been 132 (probably higher after eating) by the time lantus would have kicked in... had you shot the +12 of 54.

take what happened this morning as an awesome learning experience! this is exactly "why" we collect data. it makes us better able to make decisions in the future.

fyi: you want to see low preshot numbers when using lantus and levemir. lantus and levemir are considered "gentle" insulins. they "work" better off a lower preshot numbers. i think you've already seen that with lucian.

something we probably don't say often enough... you will not see as much of a drop from a low preshot number as the drop you'll see from a high preshot number. when a lantus/levemir user gets to the point where they have collected enough data to support shooting low and is available to monitor, shooting low is how you achieve the long flat curves lantus and levemir are known for.

mid-cycle spikes: the problem is you're trying to analyze single cycles. can't do that with lantus/levemir because the effects of these two insulins are cumulative. in other words, one cycle can and often does affect up to the next 3 days. when analyzing lantus/lev data you want to look for what i call "waves of action". single cycles can be explained by looking at what happened previously... sometimes going as far back as 6 cycles (sometimes more).

I'm considering taking him down .25 and see if he'll mellow out a little. He has become even more erratic since the increase. I'm at a loss as to what to do with him.

see sienne's comments about shooting a reduced dose. unless a kitty is over dose (which lucian is not), reducing the dose is counterproductive for the reasons sienne mentioned. take a good hard look at the spreadsheets of kitties whose caregivers have done this. what you'll see is exactly what sienne described. more often than not glucose toxicity sets in and eventually the caregiver ends up taking the dose back up... often having to surpass the dose kitty was on previously before the reduction. imho... time, money, and energy wasted. it becomes a vicious circle.

I have 2 Lev pens given to me to try, but haven't done so yet. Jill has been trying to keep an eye on him, when she can and asked me to hold off on it.

the only reason i asked you to hold off on switching to lev for a little bit is because lucian has been making progress on lantus. plus, you only have 2 lev pens and no script for more. legally, DCIN cannot help you without a prescription. however, if you want to switch to lev... go for it. there are plenty of lev users posting in this group. actually, we've probably had more lev users come through this group than the lev isg has ever seen.

Sometimes he already thinks he's a Lev kitty, with a late nadir. I just don't know what to do with him.

lantus kitties can and do have late nadirs, too. lucian's one of them. again, this is not unusual. nadirs do change.

as far as what to do with him... you're already doing it!
just keep chipping away at those numbers.



my suggestions...take him back up to 2u bid and do yourself a favor... continue posting here.

 

[nckitties3]

Re: 6/27 Lucian AM 54 Thoughts?

Thank you Jill and everyone. I appreciate your time for us.

I just get freaked out when he spikes mid cycle, much more so than low ps. I can't find the logic in that. I don't understand how it's possible.

Jill, I held off on the Lev, because of what you explained to me and that you felt he was improving on the Lantus. As I have said before, you see things I don't.

Thanks again.

 

[KarensPoe]

Re: 6/27 Lucian AM 54 Thoughts?

I'm right there with you...reading the replies on your post answered alot of questions for me too.

I think Poe is a late nadir-er too, and he runs flat on top of it, from what I can see.

Good luck...this sure is quite a dance :lol:

 

[Libby and Lucy]

Re: 6/27 Lucian AM 54 Thoughts?

I'm glad to see you posting here, Debbie. :smile: I hope you'll stay.

It has been a while since I looked in on you and Lucian (sorry about that!). I think Lucian looks MUCH better than he did a short time ago. No black, only a tiny bit of red, very little R needed, bounces clearing nicely on their own. Looks to me like you're doing a great job.

 

[Jill & Alex (GA)]

Re: 6/27 Lucian AM 54 Thoughts?

debbie, i'm on the run, but will be back later to talk about mid-cycle spikes.
i see a 212 @+8. if i were in your shoes i would get a +10 and/or +11 to see if he's rising quickly.
if he continues to rise like this you could shoot an hour or two early to help get back on schedule.

 

[nckitties3]

Re: 6/27 Lucian AM 54 Thoughts?

Unfortunately Jill, he's headed back down. +9.75/145. I was expecting him to continue up also, not a chance. SMH

Libby, I thought he was doing better too, until very recently when he started throwing me these freaky numbers at strange times.

 

[Libby and Lucy]

Re: 6/27 Lucian AM 54 Thoughts?

do what I do when I want to admire how far a cat has come: open his spreadsheet and go to the very top. Squint your eyes a little so you see mostly color, not numbers. Then hit the down arrow and scroll very quickly through the whole spreadsheet to the end. Watch how the colors change. They go from jarring to much more gentle, right? It's easy to see progress when you look at the color patterns rather than the numbers.

Coming back down is a GOOD thing!

 

[nckitties3]

Re: 6/27 Lucian AM 54 Thoughts?

I've tried that, even took off my glasses. Yes, there have been improvements in the last month, since using the R.

But he should not be coming down at this point, he should be going up. The 'smile' remember?

Getting ready to test and shoot.

 

[Wendy&Neko]

Re: 6/27 Lucian AM 54 Thoughts?

Hi Debbie, as someone who has a cat who would rather do a inverse smile (mid cycle spike) as not, glad to see I've got company over here. Neko's also has late nadirs, sometimes. :roll: If you look at the last couple of months of Neko's SS, she mostly spikes during the day and drops at night. My strategy is to figure out where I want the nadir to be and dose to that, while trying to ignore the bouncing/spiking. I've been watching your condo on Relaxed lately, quite informative.

Pretty nice cycle for Lucian today, in spite of the delay.

 

[Jill & Alex (GA)]

Re: 6/27 Lucian AM 54 Thoughts?

many of us stack numbers in a cell when recording stalls or multiple tests within an hour. the example below makes it easy to tell at a glance when the AM shot was actually given. the font size is changed to 8 and the cell has to be colored manually. it's up to you how you want to do it. just sharing.

getting back to mid-cycle spikes...

depending on where kitty is at on this journey, there might be 5 or more cycles with what most think are "crazy numbers". until a kitty stops bouncing and is able to maintain low flat curves you'll often a single "good cycle" followed by a rise (beginning of the bounce, numbers rise), then some higher numbers, sometimes a flat cycle, and then the breaking of the bounce (numbers trend downwards).

for the most part you can ignore what comes in-between the "good cycles" except to note how long they're lasting and if you can detect any patterns. the good cycles are the ones where you can actually see what a specific dose is capable of. that's the cycle you use for making dose adjustments.

isolated high numbers can have a multitude of reasons behind them. kitty may have seen another cat in the yard... the vacuum monster paid a visit... someone dropped by... commotion on the street... the garbage truck went by... kitty has a hair ball, is constipated, is waiting for you to clean the litter box or to be fed. kitty stresses, numbers spike, but then comeback down. the same can be said for a simple food spike if kitty has eaten within the last couple of hours. there are a whole bunch of things that can cause BG numbers to spike mid-cycle.

besides things like the above, some kitties will throw an inexplicable high number right before a bounce is about to break or a reduction is about to be earned. it's kind of nice when your kitty is one of those who sends this kind of warning.

recently, lucian threw mid-cycle highs in the AM cycles on 6/23 and 6/26 followed by the bounce breaking the next cycle when he dipped his toes into greens. is it a pattern? will he do it every time? probably not, but it's just something to note and keep your eyes on.

about a "smile" shaped curve...
about the only time you'll see a smile shaped curve is occasionally. at least until the kitty has stopped bouncing.

I just get freaked out when he spikes mid cycle, much more so than low ps. I can't find the logic in that. I don't understand how it's possible.

the logic all goes right back to the fact that the action of lantus is cumulative. you don't start with a clean slate every 12 hours. it's not an in and out insulin. combine that with a kitty's response such as bouncing from numbers lower than kitty is used to.................. there's just no way you're going to see a "smile" every cycle.

for example:
kitty has been running in 200s and 300s.
shoot the cat.
kitty dips into the 100s.
kitty's body freaks out because it's not used to 100s and releases counterregulatory hormones in defense (numbers zoom).
time to shoot the cat again.
the same dose is up against the powerful force of the counterregulatory hormones... can do little to pull the numbers down for the next few cycles.
shoot the cat. counterregulatory have begun to subside some. the insulin sees light at the end of the tunnel. numbers remain high, but begin to come down.
shoot the cat. numbers have lowered to a point where the insulin can pull numbers down to the 100s again.
the above can last for 72 hours (sometimes more).

same scenario... over and over again plus increasing the dose in intervals suggested in the TR protocol will eventually teach kitty's body to relax and enjoy those lower numbers.

lather, rinse, and repeat. i've over simplified the process. truth is this process *can* take months or even years... and not every kitty goes OTJ.


PS --- not a bad preshot number tonight! :mrgreen:

 

[nckitties3]

Re: 6/27 Lucian AM 54 Thoughts?

Thanks for the explanation Jill. I understand bounces for the most part and would expect them when the insulin is at it's weakest, end of cycle. But I can't seem to wrap my head around a cat bouncing almost to 500 when his insulin effect should be at it's strongest. Seems to me, if a cat's metabolic makeup is that strong, the insulin needs to work differently. There's just no logic in it. I guess, since the insulin is made for humans, there in lies the problem, it's not made for cats.

So now he wants to act 'normal', his +6 is 49. I hadn't tested since pmps, expecting him to be on the rise again and there he goes.

This is a major problem for me, if I never know when he's going to drop, how do I make an appt for anything? If/when I get WC to pick up with my PT, I'm going to have to make appts weeks at a time. At least before, I knew I had a late afternoon window where it was usually safe for me to be gone. Now I never know and don't know what to do about that.

 

[Libby and Lucy]

Re: 6/27 Lucian AM 54 Thoughts?

I'm on my way to work, only have a minute... but Jill predicted that the weird higher number in the AM cycle might have been a "high before the break." Sure enough, the bounce broke last night. It's not the first time Lucian has shown that pattern. Now you know that if you spot a strange high number mid-cycle, it might be a clue that he is planning to clear his bounce in the next cycle, and you should be prepared for low numbers. Not always, but it's a clue. And how great is it that we're considering 212 to be "high?" :smile:

Gotta run. I hope Lucian is cruising in for another good AMPS.

 

[Sienne and Gabby (GA)]

Re: 6/27 Lucian AM 54 Thoughts?

I understand bounces for the most part and would expect them when the insulin is at it's weakest, end of cycle. But I can't seem to wrap my head around a cat bouncing almost to 500 when his insulin effect should be at it's strongest. Seems to me, if a cat's metabolic makeup is that strong, the insulin needs to work differently. There's just no logic in it. I guess, since the insulin is made for humans, there in lies the problem, it's not made for cats.

That's not actually the case. There are insulins that are formulated for animals -- Caninsulin/Vetsulin (no longer available here but it is used in Europe) and Prozinc. You can see the same pattern with these types of insulin. (ETA: Jill let me know Vetsulin is available again.)

I think it may help to keep in mind that a "bounce" is a normal safety response -- annoying but normal. Lucian's body thinks that numbers have gone too low and given how well any mammal's body is developed to handle an emergency situation, those ostensibly life saving responses swing into full gear. If Lucian's liver and pancreas are responding as if the lower numbers represent a hypoglycemic crisis, glucagon (a stored form of glucose) and counterregulatory hormones are going to come to the rescue. It doesn't matter where in the cycle this happens and it doesn't really matter how much insulin you're giving. The cavalry is stampeding to the rescue and overpowering the action of the insulin.

It may also help to remember that Lantus isn't what's considered a "potent" insulin. Unlike the faster acting, non-depot types of insulin, it does not yank numbers down. Rather, it's a gentle, long-acting insulin.

 

[Jill & Alex (GA)]

Re: 6/27 Lucian AM 54 Thoughts?

sorry for bumping up yesterday's thread, but i don't see a new one started yet.

Thanks for the explanation Jill. I understand bounces for the most part and would expect them when the insulin is at it's weakest, end of cycle. But I can't seem to wrap my head around a cat bouncing almost to 500 when his insulin effect should be at it's strongest. Seems to me, if a cat's metabolic makeup is that strong, the insulin needs to work differently. There's just no logic in it. I guess, since the insulin is made for humans, there in lies the problem, it's not made for cats.

welllllllllllllllllllllllllll, than i guess you haven't seen any spreadsheets of pzi and prozinc kitties. pzi and prozinc = the insulins made for cats.
kitties on those insulins bounce, too. see sienne's comments above.

So now he wants to act 'normal', his +6 is 49. I hadn't tested since pmps, expecting him to be on the rise again and there he goes.

see libby's response above. ;-)

This is a major problem for me, if I never know when he's going to drop, how do I make an appt for anything? If/when I get WC to pick up with my PT, I'm going to have to make appts weeks at a time. At least before, I knew I had a late afternoon window where it was usually safe for me to be gone. Now I never know and don't know what to do about that.

debbie, you have to do whatever you have to do... up to and including aborting a cycle or skipping a shot if necessary. the first and foremost priority is to keep lucian safe.

take a look at alex's spreadsheet (6/20 & 21). she threw me a real curve on 6/20 (both AM & PM cycles)... one that left me scratching my head. on 6/21, i knew i had to be out most of the day and would not be available to monitor. i skipped her AM shot. yeah, it messed her numbers up a little, but in my mind skipping was better than taking any chances.

*most* caregivers leave their home to go to work everyday. lucian is not the only *unpredictable* kitty in town. there are plenty out there!
you have a cat with diabetes, but you can't let diabetes take over your life. there are plenty of experienced members here who will jump in to offer their help and advice when you're in doubt. posting on a regular basis vs posting when you have an emergency or are in quick need of advice gives them the benefit of "knowing lucian"... his responses... his peculiarities. suggestions and/or advice offered are then "tailor-made" for lucian.

make sense?