6/6 Apple AMPS 314, +4 277, +6 332 Numbers not stabilizing

Hi Caren,

Here is your last post for continuity:https://www.felinediabetes.com/FDMB/threads/5-27-21-apple-numbers-not-stabilizing.247872/

Thanks for the new thread, and sorry for all of this housekeeping, but we ask for a new post each day AND for the title threads to be changed to the following format: "DATE, NAME OF KITTY" and then all of the tests you done during the day. It's too confusing for us to have two threads with the same title for you when scanning the list of new posts. Yours today should read "6/7 Apple AMPS 314, +4 277, +6 332 Numbers not stabilizing". You can edit the thread title by going to the top right of this screen, pressing the little arrow next to Thread Tools, and replacing the text in there with the one I've provided you. This is all so that we can help you better.

You are seeing higher numbers after the reduction to 1 unit, which unfortunately means that Apple needs more insulin. Since you're following SLGS, you are obliged to hold that dose for 7 days. However, if there is no wet food in the picture and you can test often, the Tight Regulation protocol is a more aggressive way to get your cat stabilized. Here is the Dosing Methods sticky for you to review.

There is no guarantee however that you will be able to stabilize by the time the dental exam comes around. Apple is a bouncy kitty. Until her liver can get more used to lower blood sugar, it will continue to spill glucose into her bloodstream and push her numbers higher. I'm not sure what kind of numbers she needs for her dental work, but she will likely feel better once the problem is addressed.
 
There is wet food in the picture, he eats Friskies Pate on demand. Can I disregard the SLGS and start TR, I'm worried about the low dose, and as I mentioned the doctor will want him down to half dose prior to dental surgery, and that is concerning. Is there anyway to alert Wendy&Neko, to this post as well?
 
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There is wet food in the picture, he eats Friskies Pate on demand. Can I disregard the SLGS and start TR, I'm worried about the low dose, and as I mentioned the doctor will want him down to half dose prior to dental surgery, and that is concerning.
Yes, you can start TR any time you'd like and then switch back to SLGS as you need to. Please change this in your signature: Go to "Caren & Apple" at the top of this screen and click on that. It will show you a menu and you click on Signature. Then you can edit the text there to delete SLGS and replace it with TR. This will signal to everyone that you've switched protocols and we can be clear on how to advise you.

If Apple is on a half dose prior to surgery, it will be ok. She will have some high numbers for a few days maybe but better that she's high when she's recovering and perhaps not that into eating than too low.
 
Hang in there Caren (and good job on the new post :bighug::bighug::bighug:).

Nothing alarming, just bouncing - here is info on bouncing from The Basics sticky - a bounce can take up to 6 cycles to clear.

Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

If you decide to switch to TR, the earliest you would increase is tomorrow morning and it would be to 1.25u and hold for 6 cycles before increasing unless a reduction is earned - you'd take reductions for long-term diabetics (1 x under 40, 7 days between 50-100, or you can try reducing 3 x under 50). And by tagging, Wendy, she'll get an alert (though sometimes the board is a bit quieter on the weekends :bighug:).

half dose prior to dental surgery
Are you saying your vet wants Apple regulated and down to 0.5u? Or are you saying on the day of surgery, give a half dose? If it's the former, IMHO, the size of the dose shouldn't matter - I would think the vet should be looking at the overall BG numbers, regardless of the amount of insulin. If it's the later, on the day of surgery, a token dose is often okay - those with more experience can help advise when the time comes - fwiw, Jax was on 1.25u at the time of his dental surgery and I gave 0.25u the morning of his dental (and then skipped his dose that night since he was still pretty drugged up...ECID). Perhaps Wendy can weigh in on that comment too if she stops by since dental issues directly impact BG.

You're doing great and Apple is clearly very loved :bighug:
 
Southwest Pennsylvania
Hang in there Caren (and good job on the new post :bighug::bighug::bighug:).


Nothing alarming, just bouncing - here is info on bouncing from The Basics sticky - a bounce can take up to 6 cycles to clear.



If you decide to switch to TR, the earliest you would increase is tomorrow morning and it would be to 1.25u and hold for 6 cycles before increasing unless a reduction is earned - you'd take reductions for long-term diabetics (1 x under 40, 7 days between 50-100, or you can try reducing 3 x under 50). And by tagging, Wendy, she'll get an alert (though sometimes the board is a bit quieter on the weekends :bighug:).

Are you saying your vet wants Apple regulated and down to 0.5u? Or are you saying on the day of surgery, give a half dose? If it's the former, IMHO, the size of the dose shouldn't matter - I would think the vet should be looking at the overall BG numbers, regardless of the amount of insulin. If it's the later, on the day of surgery, a token dose is often okay - those with more experience can help advise when the time comes - fwiw, Jax was on 1.25u at the time of his dental surgery and I gave 0.25u the morning of his dental (and then skipped his dose that night since he was still pretty drugged up...ECID). Perhaps Wendy can weigh in on that comment too if she stops by since dental issues directly impact BG.

You're doing great and Apple is clearly very loved :bighug:
Hang in there Caren (and good job on the new post :bighug::bighug::bighug:).


Nothing alarming, just bouncing - here is info on bouncing from The Basics sticky - a bounce can take up to 6 cycles to clear.


On the day of the surgery if the dose was held at 1., then yes it would be .50. Yikes, .25, I would be a nervous wreck, and I'm a pretty stable person, except when it comes to cats. Another question I wanted to ask regarding the withholding food. Apple's 12 hour cycle is 5:00 a.m./5:00 p.m., if food is withheld after 10 p,m. or midnight and surgery is 10:00 a.m. the next morning, is there anything to be concerned about with that. The reason I ask is the vet that called for the full dental removal said that no one in this little city was capable of the dental work and to drive 4 hours r/t and pay $5,000. to a vet in Pittsburgh. So when I found a vet in town, for a lot cheaper, there's this seed planted that I should be Leary, which isn't cool.
If you decide to switch to TR, the earliest you would increase is tomorrow morning and it would be to 1.25u and hold for 6 cycles before increasing unless a reduction is earned - you'd take reductions for long-term diabetics (1 x under 40, 7 days between 50-100, or you can try reducing 3 x under 50). And by tagging, Wendy, she'll get an alert (though sometimes the board is a bit quieter on the weekends :bighug:).

Are you saying your vet wants Apple regulated and down to 0.5u? Or are you saying on the day of surgery, give a half dose? If it's the former, IMHO, the size of the dose shouldn't matter - I would think the vet should be looking at the overall BG numbers, regardless of the amount of insulin. If it's the later, on the day of surgery, a token dose is often okay - those with more experience can help advise when the time comes - fwiw, Jax was on 1.25u at the time of his dental surgery and I gave 0.25u the morning of his dental (and then skipped his dose that night since he was still pretty drugged up...ECID). Perhaps Wendy can weigh in on that comment too if she stops by since dental issues directly impact BG.

You're doing great and Apple is clearly very loved :bighug:
Yes he is very loved, along with the other group of "River Cats" that we homed when no one else would. To answer you question, if I held the dose at 1.00 on the day of surgery it would be .50. Yikes, .25, I'd be a nervous wreck. Also withdrawing food after midnight, til 10:00 a.m. surgery with a diabetic cat, is that normal? The vet that called for the full dental removal planted seeds of doubt with the competency of the local vets here, said they weren't skilled enough. She suggested a 4 hour r/t and $5,000. to another vet. So that's why all the questions etc. Thank you for all the info and do I need to make another post and highlight Wendy?
sssss
 
Thank you for all the info and do I need to make another post and highlight Wendy?
No, you tagged her (the blue with her screen name); one post per day is preferred here since there are so many kitties. I'll tag her again for you too @Wendy&Neko - Caren would love your input on switching to TR and Apple's upcoming dental :bighug:

Also withdrawing food after midnight, til 10:00 a.m. surgery with a diabetic cat
I did end up taking Jax to a dental specialist (I'm fortunate in that I could afford this and that the board certified dentist is 5 miles from my house...) and she let me do food up till midnight (he was first surgery of the day) and a small snack in the morning (like 1-2 tsp of food because Jax was quite feisty and got a pre-dose of gaba that I mixed in his food :p). During surgery, they monitored his glucose and he did just fine - I will say the glucose checks during surgery were absurdly priced - so no matter what route you go, ask about this and it may be cheaper to bring your own glucose monitor and strips for them to use (i.e. an AlphaTrak if you have one...I started with AlphaTrak before switching to a human meter and wish I knew to bring it to his surgery to cut down a bit on all the "extra" charges...after the surgery the vet said she would have worked something out with me if I had provided my own supplies :rolleyes:).
 
I got the alert, but not sure what the question was. There are many people here who can give suggestions on dose. I have no idea why you lowered the dose to 1.0 units, it's resulted in higher numbers and a 0.5 unit reduction was not earned.
 
1.0 units, it's resulted in higher numbers and a 0.5 unit reduction was not earned.
She is following SLGS and Apple earned multiple reductions on 1.25u by going <90 but the reductions weren't taken; instead she increased to 1.5u but several of us on here said to go to 1u since reductions were earned on SLGS at 1.25u (the most recent one was an 84 on 6/3 and she should have reduced to 1u but instead went up to 1.5u - here's the condo...it's in the second half of it)

Now, she's asking about switching to TR (I think more looking for your confirmation?) - so if she switches then she could increase back to 1.25u tomorrow AM else on SLGS hold 1u for the 7 days.

Sounds like she also has concerns about dental, being unregulated, and the food cut-off? Perhaps Caren can summarize her questions.
 
Regardless of the choice of dosing method, you need to stick with the parameters of the method. With SLGS, Looking back to early in May, you held the 1.25u dose for more than a week. As others noted above, you didn't take the dose reductions when they were warranted. With SLGS, reductions are taking when numbers fall below 90 on a human meter. Doses are increased if nadirs aren't where you want them for a week.

You do not have as much latitude with TR. It is a more aggressive method of dosing. Apple is a long term diabetic. As such, reductions are taken if numbers drop below 40 (or there are 3 drops into the 40 - 50 range, or she's in normal numbers for a week). If nadirs are not in normal range, the dose is increased after 3 days/6 cycles.

I strongly suspect your vet wants Apple on a half dose of insulin the day of the dental. My vet would have me skip the shot entirely. The reason behind this is that anesthesia can lower BG numbers. While I hope your vet indicated that Apple would be on an IV for both hydration and to insure they had access in case of an emergency (this is standard practice) and they will be monitoring her BG, I'm sure everyone would prefer that her numbers stay in a good range. This also means you need to be cautious once she's home. You don't want to give her a shot if her BG is somewhat low and she doesn't want to eat. (This usually doesn't happen since anesthesia can stimulate appetite but I did have it happen once with Gizmo.)
 
I got the alert, but not sure what the question was. There are many people here who can give suggestions on dose. I have no idea why you lowered the dose to 1.0 units, it's resulted in higher numbers and a 0.5 unit reduction was not earned.
O.k. what's done is done, and everyone was helpful with the information they derived from the spreadsheet. Can we get a general consensus on what dose he should be at right now so he's at somewhat of a stable state for his surgery>
 
O.k. what's done is done, and everyone was helpful with the information they derived from the spreadsheet. Can we get a general consensus on what dose he should be at right now so he's at somewhat of a stable state for his surgery>
*****Decided to do 1.0 tonight and 1.25 tomorrow morning. Confirm testing at 3-6-9 please and which # is his nadir?
 
*****Decided to do 1.0 tonight and 1.25 tomorrow morning. Confirm testing at 3-6-9 please and which # is his nadir?
If you're switching to TR, please remove SLGS from your signature and add TR. Your testing schedule is fine. If you test at +3 and Apple is low, you might need to test again at +4 and +5, because that's around the time that a cat reaches nadir or it's lowest number in a cycle. For example today he hit a low of 277 at +4, which is out of the normal range that Sienne was talking about. If you are following TR, a dose increase would be warranted tomorrow unless he drops below 40 tonight.
 
If you're switching to TR, please remove SLGS from your signature and add TR. Your testing schedule is fine. If you test at +3 and Apple is low, you might need to test again at +4 and +5, because that's around the time that a cat reaches nadir or it's lowest number in a cycle. For example today he hit a low of 277 at +4, which is out of the normal range that Sienne was talking about. If you are following TR, a dose increase would be warranted tomorrow unless he drops below 40 tonight.
Excellent, we will follow your guidance and raise tomorrow and hold it for 6 cycles.
 
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