8/9 Pumbaa - AMPS/141 -- QUESTIONS

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Pumbaa

Pumbaa

Member Since 2012
I did raise him to an even 2.50U this morning, hoping for less yellows and more blues and greens (without the greens going too low, of course).

Here is what Pumbaa did last night:

PMPS: 244
+3: 250
+7.5: 143
+8.5: 135
+9: 93
+9.5: 87
+10: 93
AMPS: 141

What is causing his body to react like this...rising at +3 then dropping throughout the night for a nadir at +9.5?

It's not a lack of food issue...he has food out and available all night and I do see him grazing, especially after testing times.

It's not the Lantus double-dip late in the cycle...it's just a continuous drop in numbers, except for the +3 where there was a slight rise.

Since his nadirs have been so inconsistent, and he has a history of diving, I have to test him constantly and I'm just not getting any sleep. Had I only tested him last night at +3, and said, "Oh, he's on the rise, I can go to bed now," I would have missed the drop down to 87. (I've been fortunate that he hasn't been dropping into dangerous numbers, that is for sure, but I increased his dose to an even 2.50U this morning, so that could change.)

Suzzzzzzzzzzzzzze (yes, I need some extra z's *LOL*)
 
Pumbaa said:
I did raise him to an even 2.50U this morning, hoping for less yellows and more blues and greens (without the greens going too low, of course).

Here is what Pumbaa did last night:

PMPS: 244
+3: 250
+7.5: 143
+8.5: 135
+9: 93
+9.5: 87
+10: 93
AMPS: 141

What is causing his body to react like this...rising at +3 then dropping throughout the night for a nadir at +9.5?
Click to expand...
I think he's looking good. :cool:

Looks like just the normal Lantus nadir shifting around, which is something apart from simply bounces clearing. Pretty common with Lantus from the spreadsheets I've looked at. Why does it happen? I don't know, but I suspect it has something to do with the pulsing swinging nature of Lantus creating cycles or ripples within the delicate balance of regulation/counterregulation.

If he gets a green below 50 he earns a reduction. Better might be to eliminate all yellow and earn a hold the dose?

And do that with only upper greens and less bouncing...
 
The "normal Lantus nadir shifting around" is killing me. :(

If he gets a green below 50 he earns a reduction. Better might be to eliminate all yellow and earn a hold the dose?

And do that with only upper greens and less bouncing...
Click to expand...

I would love, love, love to eliminate yellow and above, and hold the dose, and do it with upper greens. :)

From your keyboard to God's ear!
 
Maybe when you switch to Levemir?

If Pumbaa's not OTJ by then. It won't be that much longer.

Levemir is definitely smoother and flatter than Lantus. :cool:
 
Mmmmm . . . the usual caveat . . . I don't know any more than you do, but . . . . what if Pumbaa needs the exact number that Max needed to "breakthrough" an overdose from the beginning -- 2.75? Wouldn't that be strange? (I'm not, not, not suggesting that you raise it to 2.75, by the way. See below, please.)

What if 1.0 was too much to start with, and he had glucose toxicity? What if all he needs is to get to that dose that counteracts the toxicity? Maybe that's what the Greens at pre-shot indicate? I have no idea of course, but he's bouncing, he's on Lantus, and he's having Greens at pre-shot . . .

You know what I would do? Drop him to 0.5 or even 0.25. I would say that I would go to 2.75 but you are absolutely exhausted, and I don't think it is safe for you to start experiencing what Max and I have been for 14 days. If it took 14 days for us, and I'm almost completely thrashed, you could really be in for it. I would rather be testing for ketones all the time than feeding and testing, feeding and testing at all hours of the day and night. I recommend that you try to stop the bounce by dropping the dose, and then go up from there if you find that you have to. If he gets high BG in the Yellow and Pink that's better, imo, than spiking up and down up and down for three reasons -- 1) damage from spikes; and 2) the danger of hypo; and 3) caregiver condition.

EDITED TO ADD: It must be very tempting to keep going up, but I have to say, I have a safety net in that I live with another bean. Evenso, knowing what I know now, I'm not sure I would have gone this route with Max. It just kind of happened, and I went with it. Once I knew his infection was gone, I think, if I had to do it over, I would have dropped the dose and inched it back up instead of running this race to catch up with what the shed is doing to him and keep one step ahead.

I'm a little worried about you, Suze!

Hugs!
 
Dale said:
What if 1.0 was too much to start with, and he had glucose toxicity?
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Too much insulin does not cause glucose toxicity. Glucose toxicity occurs when a cat is not getting enough insulin and is sitting in high numbers. The cat's body 'interprets' the hyperglycemia as normal making it harder to get the numbers to come down.

The issue of dropping Pumbaa's dose has been discussed at length. See Suze's condo from July 10th. There's an excellent discussion of why reducing the dose is not the most useful strategy to deal with bounces.

I agree -- it looks like the 87 was the nadir for the cycle. Nadirs move around. They are not a fixed point. It would make all of our lives much easier if the nadir was always the same. Aside from ECID, the other factor to never forget is that we're dealing with cats. It's their job to keep us on our toes. In looking at Pumbaa's SS for the last week or so, there aren't any huge dives into below 50 territory. Gabby is one of those cats who has the reputation for diving. I get sleep. You need to look at what Pumbaa's pattern may be. (For example, do you see a high before a break in numbers? Does a flat yellow cycle signal that you're going to see an active cycle?) Even with her dropping into greens last night, what was the advantage of staying up to test? Pumbaa's numbers were very safe. I know how hard it can be some nights but you need to weigh safety against sleep.
 
Sienne:

Due to Pumbaa's past history of diving low, I simply don't know in advance when that is going to occur, so I test until he starts to go up. How low did he go overnight to have a 66 AMPS the other morning? I have no clue. But I do know that I don't want to wake up one morning and find a dead cat, or have to rush him to the ER.

And every time I seem to find a pattern in Pumbaa's numbers, he changes the pattern! Talk about keeping us on our toes...

No more dose decreases until he earns them. We're forging ahead because he does seem to be evening out some at these higher doses. Fewer bounces, fewer really high bounces, and not stuck in any high and flat ruts.

Suze
 
Ah, I misunderstood. Max was certainly overdosed as his weight was only 9 pounds or less, but he probably developed glucose toxicity after I took his dose down instead of up.

Well, Suze, I guess you just have to stick it out. You can do this, but I hate to see you struggling so. I really do think you are almost at the critical point. You need a friend there who is supportive, and could help by doing all the things that need to be done for the mother when a newborn baby comes home -- that's what you need. Maybe you could hire a vet tech or a pet sitter to come at night for a couple of hours to help test and wake you up if there is a reading below 60? There must be some one like that who needs the money.

Hang in there.
 
Dale, no worries, you are fine, and I appreciate your input. I had already decreased Pumbaa's dose back on 6/29 in case he was experiencing Somogyi rebound, and that dose decrease did shock his system out of the trend he was exhibiting. As I've said in posts after that, another dose increase might have shocked his body the same way, but we'll never know. I like to err on the side of too little insulin rather than too much. It's safer.

What Sienne was referring to on July 10th was when I decreased him again, which didn't work out for the best. Oh well, I tried something unorthodox that had worked for someone else, and it failed, and I regrouped and it was a learning experience.

Good suggestion about getting someone to spell me some nights so I can sleep, but, unfortunately I can't afford to hire anyone, and the friends I have who are nearby aren't in any position to come here and babysit Pumbaa at night due to jobs/families/medical problems of their own. The other drawback is that I don't know that Pumbaa would allow anyone else to test him. I think my vet is very happy that I am home testing because of how agitated Pumbaa became at the vet's office during the diagnosis visit...to the point that he bit me very hard, which required medical attention on my part, as well as reporting the bite to animal control. Pumbaa lets me get away with a lot, but he even gets agitated with me at times.

I am trying to get naps in when I can, and need to figure out a nap schedule that works for me, Pumbaa's numbers, my business, and taking care of my mom.

Thank you...I hate to see anyone struggling with all of this. I, too, think we are at a breakthrough point, and just wish that I could trust any of Pumbaa's trends/patterns so that I wouldn't have to test so frequently. It's hard when these patterns change daily/nightly.

What makes it really difficult is that my mom thinks I should just take care of me and go to bed at my old regular time at night, and if I wake up one morning and Pumbaa is dead, that's life. (I'm crying here. But she also thought that if she died, I would just pack her two cats up and take them to a shelter, instead of taking them into my home and continuing to love and care for them. I set her straight on this a few weeks ago.) I also have a local friend that I have known for over 25 years who gave me **** about home testing, because he had a diabetic cat and all he did was inject insulin 2X per day and take the cat to the vet every 2 weeks for a curve. He and I seldom communicate anymore.

Having you, and others, understand what I am going through means a lot to me. As do your suggestions. Thank you for that!

Suze
 
I haven't been keeping up with details, so I apologize if this has already been suggested. I was just thinking that since Pumbaa's nadir seems to be moving later, what if you moved his shot time earlier? Then you could maybe get to bed earlier. Or move his shot LATER so you are waking up closer to his nadir. You seem to have some flexibility in your schedule, at least it looks that way on your spreadsheet. Maybe there's a different shot time that would work better now.

It's tough as a single person, for sure. After treating Lucy on Lantus and Jazzy on Levemir, I have to say that if Lucy ever went back on insulin, I would probably put her back on Lantus just because Lev's later nadir doesn't work for my life. I was lucky that Jazzy was a flat, flat cat so I rarely had to worry about her dropping. Lucy, on the other hand, was a world class skydiver.
 
Libby, thank you for the input. (((HUGS)))

I already had changed Pumbaa's shot time to 7:15 am/pm from 6:15 am/pm because this gave me more time at night to nap between the +3 and the +9 readings. This has worked out much better.

Except...

...Except for the fact that his PM nadirs are all over the place! Lately, some nights it's at +6, and some nights it's not until +9. And I don't feel safe/comfortable going to bed until he starts rising again because he has a history of diving to low numbers.

If Pumbaa settled on a nadir within a 1-2 hour range every night, I could much more easily adjust my schedule to accommodate those times. As it stands, I just have to keep testing and trying to find the elusive nadir, nightly. To confuse matters even more, on 8/6 he went from 185 @ +7, to 196 @ +8, only for me to wake up the next morning to find him down to a 66! He was on the rise at +8. I thought it was safe for me to go to bed finally! I have no clue what I missed once I went to bed, but thankfully, he lived through it.

I do feel for every single caregiver who is dealing with an FD cat, whether that cat is a bouncy/diving cat or not. Daily life is hard enough to deal with, for all of us, and when you add in "world class skydivers", and dealing with aging parents with their medical problems, or just dealing with our own medical problems, or dealing with other animals, and a house and a job, it can be overwhelming. It's helps so much when there is someone else in the home to do some of the testing and spell each other for a good night's sleep! As it helps having others understand what you are going through!

Suze
 
Awwww, Suze, I understand about not being able to afford to hire anyone.

I'm really sorry to hear that your friend let you down so much. I don't understand people who feel that pets are like other "belongings." I love it when someone says, "You spent how much at the vet? You know, you can get another cat. People are giving them away right and left!" "Yeah, well, your wife can get another husband, too, dude, and I think she should!"

Really, would someone say something like that to you if your baby were sick? "You know, you can always make another one; if this one has a defect and isn't working out for you, just put it on the mountain top." Why say anything if you are so clearly going to cause the person you say it to more pain? (Because you are an a**, that's why.)

As far as your mom is concerned, I'm willing to bet she is just wishing you were not suffering so and doesn't like it that your cat is "causing" it. She loves you and if your boyfriend were stressing you out, and keeping you from sleeping, she would feel the same way. She wants fix it, and doesn't understand that what you need from her is a shoulder to cry on and moral support. So common, unfortunately.
 
Thank you, Dale, because you "get it". :)

But I really don't understand my mom, especially her assuming that I would take her two cats to a kill shelter instead of assimilating them into my house, upon her demise. And her thinking that if Pumbaa died overnight due to hypoglycemia that my misery/rough times would end.

I know she loves her cats, and she loves me. Maybe it's an age thing...I don't know.


Suze
 
It is an age thing, definitely. That, and it's cultural in general. Some areas of the country are still pretty likely to have more people who see pets as merely property. There are some very heated discussions on internet boards about whether humane euthanasia for animals is necessary when someone doesn't want to spend the money on it even if he/she can technically afford it. "We don't do it for people, so why are animals worthy of it." Of course, no one thinks that anyone will euthanize an animal for nefarious reasons either, unlike the risk with people, but I don't want to get into THAT discussion! LOL
 
Hi Suze,

I haven't kept up enough with Pumbaa to really give you anything useful other than I saw this:
How low did he go overnight to have a 66 AMPS the other morning? I have no clue.
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I don't think he did go any lower that night. His +7 and +8 were within 10 points of each other, so it looks to me that he started the cycle pink and ended it green, and the AMPS was the low point of the cycle. Like his nadir was +12?
Overall, his numbers lately look fantastic!

Good luck with the weekend project :smile:
Carl
 
Thank you for the input, Carl, and for the good luck!

I always worry about what Pumbaa is doing when I am napping, in the way of numbers. I wish I could get more +10/+11's at night, especially since his night-time nadir seems to be so much later these days.

I'm very happy that his numbers have come down so much. What a relief!

SuZzzzze
 
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