7/17 Figaro AMPS=491 Seeking opinions: dosing and data collection

Figaro's Liz

Figaro's Liz

Member Since 2019
Previous condo http://www.felinediabetes.com/FDMB/...s-567-after-greens-last-night-pmps-533.216851

Seeking opinions, please, but first I need to explain a few things (which are also reflected in Fig’s SS).

Fig’s drop seen on the 14th, I believe, did not come on from a dose of 0.75U, but a dose unintentionally closer to 1U. I have updated the spreadsheet to show his effective dosing for clarity. Sorry it is messy, but reality is also messy :blackeye:.

Explanation: Fig is nominally on the 6th cycle of a 0.5 unit dose, but I believe this dose is actually closer to 0.75 units, maybe a skinny 0.75 relative to our starting data (I’ll get back to that). He dipped to 76 (Alphatrak) out of pinks, at a nominal dose of 0.75, which I now believe now was closer to 1 unit / 1 skinny, on 7/14. This dip happened the day after I began using a new box of syringes. Bear with me...

The syringes are the same type (BD Veo Ultra fine), but I noticed the markings were much clearer on this new lot. I do not use calipers and was relying on the barrel markings. Well, last night I was poring over Fig’s SS and a lightbulb lit up. I looked really hard at the new syringe and compared it to a few of the older ones that I had kept from the earlier lot, using a paper template I made myself. The difference between the markings appears to be almost equivalent to .25U, with the new syringes effectively delivering an increased dose. (Yes, I know about calipers and I have read the stickies about fine dosing so many times. I simply have not had the mental capacity to introduce calipers to my routine, but I will be using my paper template for now. In theory I knew about the inaccuracy of syringe markings but it is truly astounding to see how much of a difference there is and the effect it can have on Figaro’s BGs).

Note, Figaro went to the vet yesterday—some small vomits repeatedly over several days, possible GI issue. I am waiting for test results but the physical exam raised no red flags. I can’t rule out an underlying issue yet, but it seems he had an upset tummy, possibly from the pumpkin/olive oil I was giving him for mild constipation, skin dryness, and hairballs (have stopped those). He is eating fine. Not sure if he is pooping fine again yet, I hope to come home to find something in the LB. I don’t know how or to what degree these issues are related to his diabetes.

I understand the safeguards of SLGS that require patience. On the other hand I understand the dangers of glucose toxicity and the stress high BGs is putting on his body… I don’t need to be reminded about the dangers at either end of the spectrum of poor regulation. It is clear from Fig’s SS that his numbers are consistently too high and of course I really want them to come down, but not too far! So I am asking for opinions to help me decide how to proceed.

I am seriously considering TR, but do not feel data-ready yet as I work full-time 9-5ish (I have been taking lots of half days off and work from home sometimes, but that is not sustainable).


Two main questions with all of this background laid out:

1) Am I wasting time at this current dose? I have accidental data that two shots nearer to 1 unit on 7/14 got greens (not limes), and that a bounce followed. Since I reduced back to an effective 0.75, I don’t know if he is still bouncing or just doesn’t have enough insulin. Do I need to simply be patient?

2) I still don’t have a great grasp on his patterns. I understand the value of data, but I am not willing to test him unnecessarily for the sake of superfluous data. I would very, very much appreciate suggestions of what spot check/curve approach would be effective. I’m planning a curve Saturday or Sunday.


Thank you in advance, everyone. You are all an amazing resource.
 
I understand about data overload - if you're not ready, you're not ready.

However, a couple of things come to mind - consistency with the dose and timing are very important. If you feel that your dose was larger - after you did your comparisons - then it may have been - that's the problem with these syringes and these tiny doses.

About all I can say, is take a breath - ask for help for someone to calibrate your syringes for you (the type you typically use) and get those calipers - Marge helped me by listing out all the numbers of what equals what - I have to say, it was a relief once I knew what the caliper setting should be - and I rely on those calipers - as with every bag of syringes I open, the marks are different...Luci is spastic enough without me giving her unreliable doses..

We're all doing our best here - and I know you are too. Just keep going along on your protocol - pushing to TR for you since you work, might not be the best idea. It does take time and patience to get those numbers to come down... take a look at @Mollycat - Biscuits - he was so high - and now look where he's at - doing better all the time - but it took a whole lotta insulin to get him to visit some better numbers...

Hopefully you'll get some other opinions - best to you in this process!:bighug:
 
Hi Liz,

I just wanted to say that I understand and have sympathy with your uncertainty. Even though we follow different protocols and I test a lot, I often have similar doubts and also feel worried, powerless and impatient when Zorro is stuck in high numbers.

Experienced members should be along to guide you shortly but I just wanted to say that.

I hope you get answers that make you feel comfortable with the way forward for dear Figaro :bighug:
 
Hi Liz, just a quick word to say that I totally empathize with you. Macka's BG looks impossible to regulate right now and bounces every time there' a slight improvement. I am distressed too, not sure about the patterns, wondering about the dose, even about the type of insulin. I don't know how bad and how fast the effects of glucose toxicity affect their bodies, I hope not too fast, so we have the time to adjust the treatment. I also feel so bad testing him non stop, hurting his ears, and wish I could just give him a good quality of life with okay numbers.

Olive oil can definitely be a trigger for upset stomach. Try to give him only good LC food, and avoir treats or extra for a little while. I stopped giving Macka Tiki stix treats two days ago and he stopped having diarrhea!

Hang in there <3 We WILL find a solution.
 
Agree with Wendy. Patience and time will be useful to see what the current dose delivers. Yes the numbers are high, but slow changes are easier to track. It will be good to see if any more blues or greens emerge, like the earlier ones.

Glad to hear that Figaro's vet visit went well. Maybe it was just a hairball or upset stomach. In Leoberry's earlier life he used to deliver a small watery puke every night. I think he was just used to having food in there all the time, and the 4 - 6 hours without food upset him.
 
@Sue and Luci Thanks for your advice and encouragement :). I think I will get the calipers soon, for peace of mind. I'm hoping that having the tool in front of me will help me understand exactly how that works; I trust that with so many people here using them successfully, they are helpful. Maybe it's the kind of thing where you don't know what you're missing 'til you try them out?
Luci's SS is so interesting. I hope the Levemir helps the "spastic"ness a bit! I like to check out the early parts of everyone's SSs. I had to chuckle a little when I saw your notes about Luci eating bread and kit-kats! Oh my!

@Zorro's mom Maritsa, thank you for the support, again, it does make a difference to know I am not alone, and that while we want to do everything we possibly can, the best thing is to sometimes just wait, hard as it is. I'm sorry that you also feel the uncertainty and powerlessness, that is exactly right.

@Wendy&Neko Okay, I'm putting on my patience pants even though they are still pretty itchy :oops: Much as I have been studying the board, I haven't wrapped my head around what bouncing actually looks like, since Figaro has been so consistently high anyway. So, I'll wait.
Re TR: I could get a +2 when I go out the door before work, and I could monitor at night. It's a possibility, so I will keep considering it. Much appreciative of your practical advice. We'll see how Fig's doing tonight!

@Penelope and Mačka I feel like Macka and Fig are on kind of parallel tracks! And so I really feel for your distress in return. I too hope we have some time to get in front of glucose toxicity--I guess it is probably an ECID thing, and depends on many factors.
Maybe I need to be careful to not overdo it, trying to make things better by doing the wrong things, even if well-intentioned. I will work harder than anyone, but sometimes that doesn't actually help. I completely hear you on just wanting to provide Macka with QOL. I just want Figaro to be better! Reading other kitties' spreadsheets gives me hope that things will level out, and move forward. It is a roller-coaster right now though, isn't it?

@JeffJ I wondered that about Figaro too. I used to only feed him once per day (wet and dry... yikes, never again!) and he would graze, but maybe he is not completely used to the all-canned and different feeding schedule (it has only been a month, though it feels like a lifetime already!).
 
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