9/26 Clare AMPS 365;+2.5-372;+4.5-307;+8-320

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Georgette and Clare

Georgette and Clare

Member Since 2014
Good Morning, Lantus Land neighbors!

Yesterday's Condo with Weird Numbers on SS

We're sending healing wishes and hugs to our neighbors who need them this morning.

Today's News:

AMPS 365
+2.5: 372
+4.5: 307
+8: 320

We had some issues yesterday with measuring Clare's BG at the vet's while checking our glucometer against theirs. I still haven't figured it out: it's on the SS.

In the meantime, Julie has advised that we reduce the dose, so we'll do that beginning this PM. I'm beginning to wonder if Clare might be better off using another type of insulin. I don't quite understand why she's continuing to bounce. Her last bounce was longer than usual and we're seeing more of the stinky pinkies and less of the yellows during her bounces.

Finding a good dose for Clare has been quite a mystery. ;-)

Have a great day, Everyone!
 
Re: 9/26 Clare AMPS 365

Yeah, finding a good dose is definitely a challenge, that's for sure! It makes it hard when we KNOW the dose is based on the nadir, but a kitty is bouncing. Just remember that nadir, though...no matter how high a kitty bounced on a given dose, if they hit a low nadir once, they can do it again. It defies logic, but that's good ole FD for ya!

I'm not surprise the tests you got with the blood sample you brought home were wonky...seems like an odd thing for the vet to ask you to do, rather than just do another ear prick when you got home. Did you happen to do an prick and test yet again? That might have given you a more solid answer.

Have a great day, Clare!!
 
Re: 9/26 Clare AMPS 365

Some kitties are more bouncy than others. It can drive you crazy. It is easy to focus on the high numbers and not the nadir when they bounce like that. I've done that with Furball before. Good luck finding a good dose. The whole thing with the vet sounds strange to me. I would think that taking blood home would be the cause of the weird numbers.
 
Re: 9/26 Clare AMPS 365

Thanks for helping me think about this, Amy and Carla.

I had asked if I could take the blood home from the vet's because I had brought my last test strip with me and couldn't re-test when we came up with such different numbers there at her office (90 for her on the AlphaTrak and 42 for me on the ReliOn). So the blood was probably wonky by the time I got back. It was blood that they'd taken when they took blood for her lab tests, and not an ear prick.

When I got home, I did retest Clare and her BG was 77.

So the 42 seems plausible, except that we did the comparison much later than her usual nadir, at +8.

Things seem almost back to normal (except high) today. She ate a good breakfast. She didn't want to go out on a walk just now, though, which is very unusual for her. The vet will be calling to talk about her lab report this afternoon so we'll know more. Nothing turned up on her physical exam.

Georgette
 
I wanted to respond to your pm here.

Today Clare is bouncing from yesterday's green day cycle.

Let me preface things by saying that you don't HAVE to reduce her dose from the 0.5u. I could definitely make a case for holding the dose for her and seeing if the higher numbers would come down.

From your pm, it sounds like you're trying to avoid letting her earn a reduction, and that changes my opinion. If a cat isn't holding reductions well, then you can go to plan B.

One option is to let her drop below 50 three times before you reduce her dose.

Another option is to shave the dose each time she goes below 50 and see if she holds that type of reduction.

Don't mix and match those 2 options, though. If you let her go below 50 three times and then shave, you're creating a situation where her depot may now be too big for her needs.

When you're trying to prevent a reduction by giving her food and raising her nadirs (so she doesn't go below 50), you just need to be aware that if you are having to give her a lot of volume of food, or a lot of carbs in that food, you may also be setting the scene for a depot that is getting too large for her needs. When that happens, you can cause low numbers that take a lot of work to keep up. So you want to do a balancing act - in general, giving as much insulin as you safely can is really a great idea and will help bring down the whole range and possibly flatten out her numbers. That's why we typically see cats have to go up the dosing scale until something clicks, it's finally enough insulin, and then they start getting into better numbers. That's when the opportunity happens for her pancreas to heal - when she's in the 50-120ish range.

If you want to continue giving the 0.5u, you certainly can - just be aware of these concerns and watch for signs that she needs a dose reduction. If she goes into the 30's, then for safety's sake, you really do need to reduce the dose.

Does that all make sense?

And as far as some spreadsheets - Shelly's Jersey bounced all the way to OTJ. Bouncing doesn't prevent the cat from going off of insulin - it's a good safety mechanism that will prevent a hypo as the cat is getting into lower numbers. So it's not the enemy - even bouncy cats do work off. Some interesting spreadsheets are linked in this post i wrote for Darin/Charlie a while ago about shooting the regular dose into normal numbers here.

Did i answer all of your questions? I have to run out now but will check back in with you later this evening.
 
I guess Clare's inactivity this morning was just her vetty exhaustion from the big day yesterday. Haven't heard today about her labs so I guess that will wait until Monday. She did say that something about Clare's kidney values needs talking about. nailbite_smile

Tonight we're going to reduce her dose to 0.25. I thought it also might be a good idea to go back to feeding her only 4%. So we'll see how that goes this time around. Maybe it will help us to have more yellows during her bounces, instead of pinks. We'll still feed her two breakfasts and two dinners. I guess you just have to try different combinations of strategies and hope one does the trick!

Later: found out that the 42 reading at the vet's was an error, maybe a bad strip. The independent lab that did the analysis on her blood came up with a BG of 113.

Have a good night, Everyone!

Georgette and Clare
 
Hi Julie,

While I'm digesting your note I just wanted you to know that my last post was written before I read yours. So I'm thinking on what you've said and will be back shortly.

Thanks so much for giving your time to this!

Georgette and Clare
 
Hi Julie,

I think I understand what you've said along with the different options that you've explained that we have at this point. Some thoughts:

(1) First of all, I think I've generally had the wrong approach to managing Clare's cycles under the protocol. I actually thought I should give her food while she went lower to prevent her from going into the 40's. I didn't realize that you're supposed to let her cycle naturally until she hits 50. Sheesh! ohmygod_smile

(2) That being said, it's true that in this most recent dosecrease to 0.5 I've been managing her food even more deliberately so that she doesn't earn a decrease. That's because we've been at 0.25 and 0.25+ before, and at those levels we haven't been more than one or two times where Clare has had any long, deep green cycles. So those levels just don 't seem to be effective enough. I think I need a lesson here: sometimes what seems insufficient at one stage of healing may be just right at another stage. True? Maybe I need to "get that" somehow.

(3) When we went to the most recent dosecrease of 0.5, it was suggested that we try mixing Clare's food to be 1/2 4% and 1/2 8% at main mealtimes, in order to try slowing down the dives she was doing, that led to the subsequent bounces. It wasn't an attempt to offset the higher dose generally but I can see what you're saying about that practice potentially leading to too large of a depot. I've also been generally anticipating her lower nadirs with higher carb food: When Clare got to around 60-70 I would start feeding her the higher-carb foods primarily because with her speedy dives being so steep, I do the math then would be worried that she might go even lower than the 40's before the food would kick in. Should we go back to feeding only 4%, do you think?

(4) True confessions! I'm generally okay with managing Clare's low cycles, day or night, and I just want to be sure we 're doing the best we can for her and keeping her safe. Whatever it takes -- even patience! ;-)

(5) JUST OFF THE PRESSES: We just heard on the labs that Clare had done yesterday. It was a voicemail message. Clare's BG was in the normal range - 113. So the 42 we got with our ReliOn was off. Given that and that one option is to continue the dose and watch for the low nadir, I guess we'll do that. I've learned so much through this exchange -- I'm glad the bad strip (which I guess was the cause of all the confusion) was in the pack.

(6) To add to the soup: On Tuesday we'll be gone during the AM cycle because I'm having a surgical procedure. We thought we'd reduce the dose to 0.25 on Monday night, then raise it back to 0.5 on Tuesday night when DH would be home to monitor. Do you think that would be okay?

Thanks again, Julie, for your guidance.

Georgette and Clare
 
In general, people don't give high carbs until the cat goes below 50. Part of the reason for that is that you want the cat to spend as much time as possible in normal numbers, so you don't want to give carbs as soon as they get there and shoot them back up. But, if you're feeding in order to manage her curve and slow her dives, that's a-ok. Feeding a curve to slow down diving is a little different than preventing a cat from going below 50. does that make sense?

I think I need a lesson here: sometimes what seems insufficient at one stage of healing may be just right at another stage.
Click to expand...
absolutely true!

i agree with you that she looks better on 0.5u than on 0.25u. the goal is to keep her in those normal numbers as long as possible, hopefully giving her pancreas an opportunity to heal and switch back on.

You do a FANTASTIC job of taking care of her, Georgette! No doubts there! You're almost at the tweaking phase - she's looking pretty good.

Regarding the glucose measure from the lab - what is the normal or reference range they are using for that? Labs typically come with a column next to the name of the test that lists what is called either normal or reference range. That's important in knowing what that 113 means. No matter what, it's good. I'm thinking they may be using a pet-calibrated test, so it would be like if you were using an AlphaTrak glucometer.

Your plans for Monday- Tuesday sound good to me.
 
Julie -- you're a comfort! :-D

I think I understand the distinction between using food to manage the dives vs. prevent the dose reduction. I'll keep that in mind.

The lab report is still at the vet's but I'll pick it up on Monday and let you know more about it. There usually is a reference range, and I think you're right about it being tailored to animals because it's a veterinary lab here that does the work. For what it's worth, on the voice message, our vet said that the 113 BG was normal.

I'm glad the Monday-Tuesday plan looks okay. We'll use that, then.

Have a good night!
 
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