8/18 Toronto AMPS 363 dosing advice please

[Toro & Ovi]

Hi friends, I'm a little bit puzzled by Toronto's numbers.......good numbers followed by big bounces...........dosing advice, please.
He seems to have the nadir around PMPS or 1-2 hours later.
Been on 1u for a month now, with short tryouts on 0.75u and 1.25u ( on 1.25u went from 440 to 77 in less than 24 hours - brutal).
No food 2-3 hours before PREI as a rule.
The vet is pushing for Hills diet food to regulate the numbers, which we keep refusing as we believe Fancy Feast pate are low enough in carbs - has this anything to do with Toro's numbers getting regulated so hard?
Thank you.

 

[Marje and Gracie]

Based on the SS, I assume you work out of the home during the days?

The reason it seems his PMPS is his nadir is because it looks like he is clearing bounces. When that happens, the lowest number is often around +12/+13.

In many cases, there is easily only a 20% variance between his AMPS and PMPS so while the PMPS "might" seem lower, he could be fairly flat or he could be coming down during the day and popping right back up. I've seen this in many cats, including my own where AMPS was pink, midcycle green, and PMPS pink. When you aren't able to get a midcycle test, you don't know how low they got during the day.

I think we need to do a little investigative work here. When I see AMPS in high pink and red with a few nighttime numbers in blue at the 1u dose, it throws up a flag to me that he could be going lower....not necessarily low...at night or he's taken a dive somewhere. Therefore, before we make dose changes, it would be good if you are willing to grab a few more tests.

My suggestions would be:

• Are you able to be up any earlier in the mornings so you can grab a +2 before you go to work? If not, I would grab and "out the door" test unless you leave as soon as you test, feed, shoot.
• It would be helpful to get an "in the door" test when you get home from work unless you walk in from work and have to test, feed, shoot
• A +2 and "before bed" test every single night that you possibly can will be very helpful for us to start putting the pieces of the puzzle in place.
• On weekends, I'd do random spot checks, getting a +2 each cycle as much as you can and then getting different tests. For example, one cycle on the weekends, you might want to get a +2, +4, +7, +10 and another you might try a +2, +5, +8.

Let your meter be your guide. We've found that the +2 can be indicative of what the cycle might look like. If the +2 is similar to or less than the preshot, you're likely to see an active cycle. If it is a lot less than preshot, it's going to be a very active cycle.

Once we can see what he's doing and where he's dropping, we can decide on the dose and also, I can help you with managing the curve with food to help minimize the drops.

A fast drop will often result in a harder bounce than a lower number. The goal is to flatten out the cycle by minimizing the drops and bringing the nadir up a bit.

I'm not suggesting that you become a testaholic like some of us, including like I was. But if you are willing to do a bit more testing while we figure out what he's doing, it will pay off in the long run.

Questions or thoughts?

 

[Marvin's Mom - Nat]

The vet is pushing for Hills diet food to regulate the numbers, which we keep refusing as we believe Fancy Feast pate are low enough in carbs - has this anything to do with Toro's numbers getting regulated so hard?

In my case Vet wanted ProPlan DM, I did it but couldn't afford it after a while, so I would switch it up FF during the day and PP DM in afternoon. However I noticed that Marvin did better with FF. So I took PP DM out completely, and now I use FF and Friskies.

 

[Toro & Ovi]

Based on the SS, I assume you work out of the home during the days?

The reason it seems his PMPS is his nadir is because it looks like he is clearing bounces. When that happens, the lowest number is often around +12/+13.

In many cases, there is easily only a 20% variance between his AMPS and PMPS so while the PMPS "might" seem lower, he could be fairly flat or he could be coming down during the day and popping right back up. I've seen this in many cats, including my own where AMPS was pink, midcycle green, and PMPS pink. When you aren't able to get a midcycle test, you don't know how low they got during the day.

I think we need to do a little investigative work here. When I see AMPS in high pink and red with a few nighttime numbers in blue at the 1u dose, it throws up a flag to me that he could be going lower....not necessarily low...at night or he's taken a dive somewhere. Therefore, before we make dose changes, it would be good if you are willing to grab a few more tests.

My suggestions would be:

• Are you able to be up any earlier in the mornings so you can grab a +2 before you go to work? If not, I would grab and "out the door" test unless you leave as soon as you test, feed, shoot.
• It would be helpful to get an "in the door" test when you get home from work unless you walk in from work and have to test, feed, shoot
• A +2 and "before bed" test every single night that you possibly can will be very helpful for us to start putting the pieces of the puzzle in place.
• On weekends, I'd do random spot checks, getting a +2 each cycle as much as you can and then getting different tests. For example, one cycle on the weekends, you might want to get a +2, +4, +7, +10 and another you might try a +2, +5, +8.

Let your meter be your guide. We've found that the +2 can be indicative of what the cycle might look like. If the +2 is similar to or less than the preshot, you're likely to see an active cycle. If it is a lot less than preshot, it's going to be a very active cycle.

Once we can see what he's doing and where he's dropping, we can decide on the dose and also, I can help you with managing the curve with food to help minimize the drops.

A fast drop will often result in a harder bounce than a lower number. The goal is to flatten out the cycle by minimizing the drops and bringing the nadir up a bit.

I'm not suggesting that you become a testaholic like some of us, including like I was. But if you are willing to do a bit more testing while we figure out what he's doing, it will pay off in the long run.

Questions or thoughts?

Thank you, Marje. You are helpful an always. We'll try to get more readings during the day in the future. Can you please explain "active" and "very active" cycle? Are you referring at the night drop as small drop or big drop ?

 

[Toro & Ovi]

In my case Vet wanted ProPlan DM, I did it but couldn't afford it after a while, so I would switch it up FF during the day and PP DM in afternoon. However I noticed that Marvin did better with FF. So I took PP DM out completely, and now I use FF and Friskies.

Thanks, he loves Friskies and somehow FF. As a little bit higher on carbs than FF, we keep Friskies only as treat if he gets too low. For now.

 

[Marje and Gracie]

Thank you, Marje. You are helpful an always. We'll try to get more readings during the day in the future. Can you please explain "active" and "very active" cycle? Are you referring at the night drop as small drop or big drop ?

You're welcome.

An active cycle is where you would see the BG gradually decrease to nadir (usually midcycle) and then gradually increase. A very active cycle is where the +2 is much lower than the preshot and the BG continues to drop rapidly. How rapid? Well, ECID and that's what we have to find out. For my Gracie, I knew if she dropped 50 mg/dL in an hour, it was going to be a very active cycle but that was just her. We determined that through testing. You might find it is more or less for Toronto.

The other important thing to note, and I see this "urban legend" frequently in this forum, is that cats don't necessarily drop at aa steady rate. For example, let's say that in two hours, Toronto drops 100 mg/dL. You can't assume he dropped at 50/hour. He might have dropped 30 the first and 70 the second. It's these kinds of things we learn about our cats through testing because there are methods, that have worked quite successfully for many, to minimize and even change that pattern of diving. But you have to be a bit of a sleuth through the testing

 

[Toro & Ovi]

You're welcome.

An active cycle is where you would see the BG gradually decrease to nadir (usually midcycle) and then gradually increase. A very active cycle is where the +2 is much lower than the preshot and the BG continues to drop rapidly. How rapid? Well, ECID and that's what we have to find out. For my Gracie, I knew if she dropped 50 mg/dL in an hour, it was going to be a very active cycle but that was just her. We determined that through testing. You might find it is more or less for Toronto.

The other important thing to note, and I see this "urban legend" frequently in this forum, is that cats don't necessarily drop at aa steady rate. For example, let's say that in two hours, Toronto drops 100 mg/dL. You can't assume he dropped at 50/hour. He might have dropped 30 the first and 70 the second. It's these kinds of things we learn about our cats through testing because there are methods, that have worked quite successfully for many, to minimize and even change that pattern of diving. But you have to be a bit of a sleuth through the testing

Thank you. One more question though: the extra tests around the clock, should be done with an empty stomach (at least 2 hours after feeding) or doesn't really matter?

 

[Bobbie And Bubba]

Hey there and welcome!

When grabbing tests through out the cycle I found it best to align my test with the mini meals I gave Bubba so that the test was not a food induced number and I could get a better idea of just how low the Lantus was taking him.

 

[Marje and Gracie]

Thank you. One more question though: the extra tests around the clock, should be done with an empty stomach (at least 2 hours after feeding) or doesn't really matter?

Depending on Toronto's feeding schedule, you might or might not be offering a meal. If you are testing at a time where he normally gets food, test first. If he's running lower and you are monitoring the numbers, always test and then decide what you will feed.

 

[Toro & Ovi]

Depending on Toronto's feeding schedule, you might or might not be offering a meal. If you are testing at a time where he normally gets food, test first. If he's running lower and you are monitoring the numbers, always test and then decide what you will feed.

Thank you.

 

[Toro & Ovi]

Hey there and welcome!

When grabbing tests through out the cycle I found it best to align my test with the mini meals I gave Bubba so that the test was not a food induced number and I could get a better idea of just how low the Lantus was taking him.

Thank you.

 

[Marje and Gracie]

Thank you.

You're welcome.

One other thing....We can help you best if you can do three things for us please:

• Post a new thread every day
• Keep the SS updated
• Grab the tests; none of us will give solid dosing advice without having a decent idea of what Toronto is doing. For example, it would have been best to have tested last night with a blue PMPS. I guarantee you he went lower but I can't guess how low and if it's low enough that he needs less insulin or he's not quite getting to green and he needs more.

 

[Toro & Ovi]

You're welcome.

One other thing....We can help you best if you can do three things for us please:

• Post a new thread every day
• Keep the SS updated
• Grab the tests; none of us will give solid dosing advice without having a decent idea of what Toronto is doing. For example, it would have been best to have tested last night with a blue PMPS. I guarantee you he went lower but I can't guess how low and if it's low enough that he needs less insulin or he's not quite getting to green and he needs more.

Thank you, we'll try to get some numbers these nights. We agree that something out of charts happens at night and we have to find out what. Days numbers seems to be predictable but the nights ones not so much......

 

[Marje and Gracie]

Thank you, we'll try to get some numbers these nights. We agree that something out of charts happens at night and we have to find out what. Days numbers seems to be predictable but the nights ones not so much......

Great but I wouldn't agree the days are predictable. He could very well be coming down and going right back up. That's why daytime tests, when you are home, are really important.

 

[Toro & Ovi]

We did day tests yesterday and like never, after a very good and active day, with him sitting with us almost all day and going on long trips in the backyard, the numbers skyrocketed between +9 and +12. He never did this before on 1u for at least 5 days so we can't explain it - one atypical day. We reserve the night tests for one of his typical 24 hours in which he's very low at PMPS (after a high AMPS) in order to see the curve during the night and catch the moment when he goes high for his next AMPS.
We take him tomorrow for a fructosamine test and see what the vet says. Keep in touch.

 

[Marvin's Mom - Nat]

To me that is not really a sky rocket, it looks like a normal up after nadir for kitty that still needs to be regulated. He is doing a bit better, once he starts having better numbers and he get used to it.... then the cycle will flatten out a little. I think it may feel that way, because before his numbers were not following the typical lantus pattern, the couple NS, and change in dosage.... it maybe time to try 1.25 again...

 

[Marvin's Mom - Nat]

Come on Toronto, work the juice or may have to take you to Blue Jay's game

 

[Marje and Gracie]

We did day tests yesterday and like never, after a very good and active day, with him sitting with us almost all day and going on long trips in the backyard, the numbers skyrocketed between +9 and +12. He never did this before on 1u for at least 5 days so we can't explain it - one atypical day. We reserve the night tests for one of his typical 24 hours in which he's very low at PMPS (after a high AMPS) in order to see the curve during the night and catch the moment when he goes high for his next AMPS.
We take him tomorrow for a fructosamine test and see what the vet says. Keep in touch.

I agree with Nat. That looks like a very normal curve.

Please remember to start a new thread each day or they can get really long and hard to follow. We do one thread per cat per day with all info and questions in that one place. Thank you!

 

[Toro & Ovi]

Thank you. I don't want to jinx it, it's the first day when we see a so called normal curve during the day, after 5 weeks of Lantus. We hope we'll see them few more days of that before making the decision on changing the dose up. Let's see what the fructosamine test tells us tomorrow, too.
Stubborn tomcat. He's going to look at me as his enemy for 4-5 weeks after that again for taking him to the vet.
He's a funny guy today again. Fingers crossed.
P.S. We either missed his nadir today or he stayed in the high range all day. No duplicate for yesterday.