9/4 Sparky PMPS 65 +1 57 +4 50 +5 54

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Aly & Sparky

Aly & Sparky

Member Since 2010
We just got internet back since the hurricane so I haven't posted in a while. Today was the first day we really seeing double digits. A little nerve racking but I'm happy and he looks great, put back on some weight and his coat looks good again. I'm certainly more comfortable with TR with Lantus than I was with PZI. I'm definitely liking this insulin!! :-)
 
Re: 9/4 Sparky AMPS 68, +4 40 +9 77

Aly:

Please read this post on handling low numbers. Testing and getting a 40 really requires a lot more testing to make sure the numbers are stable. A pre-shot of 68 requires that you follow up with tests at +1 and +2 at minimum. I'm sorry if this sounds a bit harsh but I'm concerned about how long Sparky spent in low numbers and what you did to bring those numbers up.

I realize that with the hurricane and all that has been disrupted Sparky's spreadsheet may not be up to date. However, if what's there is all that you've been testing, you really need to get more test data given what you've seen today. It's quite likely that Sparky's numbers have been dropping low and he's been bouncing back up. The only way you're going to have an idea about what's going on is to get more test data.

With that 40, Sparky earned a dose reduction.
 
Re: 9/4 Sparky AMPS 68, +4 40 +9 77

Sparky definitely earned a reduction. Do you know what last night's numbers were?

Keep in mind that even though you'll be reducing tonight, Sparky will have some extra shed action going on between the early shot this morning and the carryover from the old dose. Be sure to keep monitoring tonight until he gets past nadir or until the bounce starts.
 
Re: 9/4 Sparky AMPS 68, +4 40 +9 77 +12 65

He was 65 at +12 and I gave the full .5, I hadn't read your posts yet.

I'll get a +1 and a +2 and post the results.
 
Re: 9/4 Sparky AMPS 68, +4 40 +9 77

Usually, your +1 would reflect a food spike. That it is lower than your pre-shot test, suggests this could be an active cycle. Please get a +1.5 and a +2.

Do you have a supply of strips and high carb food?
 
Re: 9/4 Sparky AMPS 68, +4 40 +9 77

you might as well feed some high carb gravy. This is too early to be that low. He has already earned his reduction today, so it's ok to abort this cycle by bumping the numbers up. Please test again in 15 minutes.

Can you do me a favor and change the subject line in your first post of the day, so the current numbers will show up in the subject line on the main page?
 
Re: 9/4 Sparky AMPS 68, +4 40 +9 77

Just tested again, he's been napping with me (sorry i did doze a little), he seems fine. +2.5 he is 49. I'll keep checking him, next at +3. He still has his regular food out and he's been in and out of the kitchen, he's a grazer.
 
Re: 9/4 Sparky AMPS 68, +4 40 +9 77

Let Sparky graze on high carb food. If you don't have any in the house, mix some Karo or honey or maple syrup into his regular food. His numbers are going to keep dropping given how early in the cycle it is. You don't need to prove anything since Sparky has already earned a dose reduction today. Get his numbers up, please.

Please change your subject line. You need to edit in your first post in this thread. Click on the "edit" button, change the subject line so it has your PM data, and then click on "submit."
 
Re: 9/4 Sparky AMPS 68, +4 40 +9 77

here's the thing... you don't know when Sparky's onset or nadir are. In the "typical" Lantus cycle, the insulin is probably just now starting to kick in. That means that the drop he has already had in this cycle is really leftover action from the last cycle. He is probably just about to *start* dropping from this shot, and he's already in the 40s.

Then for most Lantus cats, the nadir is around +6, sometimes later. That means Sparky probably has at least 3-4 more hours to drop and maybe more than that. We know the dose is too high because he hit 40 today and hasn't bounced yet. With those factors, and the fact that so far he has not gotten any bump up from his low carb food, my recommendation is to feed small amounts of gravy and test every 20-30 minutes until he is surfing past nadir.
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49

When you refer to "bounce" does that mean the regular rise of BG after nadir or a type of rebound effect after dipping too low?
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49

a bounce is the second option you mentioned - when a cat dips lower than they are used to the liver releases stored glucose and counter-regulatory hormones which sends the BG high.

the concern is that cats on lantus can dip too low without the obvious signs of hypoglycemia - they still need attention to pull them up from low numbers even if you don't see visible signs. we start treating cats for low numbers when they go below 50. you want to follow the process that libby mentioned - test, give gravy, wait 20 minutes and retest repeatedly until sparky is safely past the nadir and staying securely above 50 or 60.
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49

either/or. You need to wait for a significant rise before sleeping, whether that rise comes naturally after nadir or whether it comes from a bounce (I don't like to call it rebound because people tend to get that effect confused with chronic rebound).

Most cats would have bounced from the 40 today, especially since most of his numbers have been higher. The fact that Sparky hasn't bounced probably means that this is not the first time he has been that low recently. Once a cat is over dose on Lantus, it can be very hard to get the numbers back under control. Add to that the fact that his pancreas might be sputtering and you could be in for a very, very long night. We already know Sparky is over dose, but we don't know how far.
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49

+3 44

Looking very similar to this morning's numbers. Waiting to see what he does between +4 and +9- a gap i wish i saw earlier today when he went from 40 back up to 77. I'll stay up with him a while. ~O)

I'm hoping he is sputtering. We had him diet controlled for so long, about 6 years I believe. I think he's back on the juice because my boyfriend started feeding him higher carb wet food than normal a few months ago. Would be great to ease him back otj if possible...
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49

Hi Aly, u should keep an eye on Sparky & do test every 20mins coz' this is too early in the cycle to have 40s, u seems not sure when his nadir is, he may go lower than now in the coming few hours. I suggest u to give him a teaspoon of hc gravy or food to bump up his number b4 the nadir, and do test every 15-20 mins.
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49

I am not giving him high carbs but i am monitoring closely. I practiced TR with him before and I know him well. 30 is my threshold and even at 28 he didn't have clinical hypoglycemia (symptomatic). Not that I want to see those numbers. I rather be asleep right now. BUT I rather stay up and watch then throw carbs in the mix, at least at this point. I promise you I have his best interests at heart.
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49

I believe that Aly is familiar with a different protocol for tight regulation than the one we use.

I would point out that the Hodgkin' protocol was developed for PZI and not Lantus.
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49

i'm unclear why you wouldn't want to give him the high carbs. even though you aren't seeing symptoms, it isn't good for him to be coasting along this low.

i am not familiar with the PZI tight regulation, but i know there are significant differences in the way Lantus works. With Lantus, the protocol is to bring numbers up above 50 when they go lower and not let the cat sit lower than 50.

With Lantus, you also reduce the dose when the cat goes below 50 - so definitely plan to reduce sparky to .25u in his morning shot. because Sparky was OTJ and only went back on insulin a short time ago, he's in the "newly diagnosed diabetic" category.

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
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Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49

Aly

When you let a cat stay in numbers under 40 for long lengths of time, you are risking damage to brain cells from low blood sugar. None of like using carbs but as Sandy said the other day "one day at high numbers is safer than one hour at low ones". He's low very early in the cycle and when he onsets, he could plummet quickly so watching him isn't going to help. It's important you get his numbers up before he onsets. I have shot 50s fairly often and the first thing I do is get her up before she onsets.
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49

I don't understand why you would shoot at a low number and follow the insulin with carbs and karo. Why not just stall the shot for a few hours? Every time I've given Sparky carbs it unregulates him and we start the whole process over again. I'm not saying I shouldn't start shaving his dose down.

Just did his +4 and it was 50 and he hasn't eaten since +2.
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49

Aly & Sparky said:
In my google research i've found several sources for information on TR with Lantus.
http://www.tillydiabetes.net/en_6_protocol2.htm
They report surprisingly high remission rates. Does anyone else on this board use protocols like those?
Click to expand...
welcome back, aly!
you could have saved yourself some time searching by reading the STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL. :mrgreen:

following a tight regulation protocol (tillydiabetes & rand are now one in the same) is what we've been doing here since 2007.

it appears you subscribe to Dr. H's theory that a cat will not have a symptomatic hypo if exclusively fed a low carb wet diet.
we haven't seen many symptomatic hypos when kitties are on an all wet low carb diet, BUT we have seen some. just wanted to let you know it's not unheard of. you might want to give it some thought...



edited for spehling!
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49

Aly & Sparky said:
I don't understand why you would shoot at a low number and follow the insulin with carbs and karo. Why not just stall the shot for a few hours? Every time I've given Sparky carbs it unregulates him and we start the whole process over again. I'm not saying I shouldn't start shaving his dose down.
Click to expand...
it all depends on where the drop is in the cycle and how carb sensitive your kitty is. ECID.

not everyone carbs and karo. i don't. and i don't stall either because stalling drains the insulin depot and optimally, you want to use overlap to your advantage. BUT... i know my cat (on lev, not lantus, but same principles apply)... and i suspect you soon will too since you're not new to this. lantus just takes a little getting used to. it's a lot different than pzi. the action of lantus is cumulative. one dose can affect up to the next three days...
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49 +4 50

Hi Jill!

To be honest I didn't like Dr. H that much back when we used PZI but PZI was such a different ballgame, much scarier drops. I'm surely watching for symptoms and am ready to bounce if need be. Sparky is hanging out with me tonight. I will note though that I stupidly gave him a wrong dose on 8/18 and he dropped to 28 with no symptoms. I wasn't happy about it, but it was indeed interesting. I'm hoping to keep Sparky in the green full time, I know that not everyone is comfortable with it but hopefully my data, whether it turns out to be good or bad, will be helpful to someone. No?
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49

Jill & Alex said:
one dose can affect up to the next three days...
Click to expand...

Wow. Then i can see not wanting to stall. It's also probably why it took us this long to get green numbers, i was doing horrible with keeping to the 12 hour schedule. I do have three little beans now so it's quite hectic here!
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49 +4 50

24/7 is what i aim for with alex. if she didn't have other problems going on, her ss would be all green. when she's not relapsing or having a CP flare, she is green 24/7. this is her third stint on insulin though. one honeymoon lasted for almost 3 years. second honeymoon for only around 5 months. she's been back on insulin since march 2010. doubt she'll ever see a honeymoon again, but who knows?
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49

Aly & Sparky said:
Wow. Then i can see not wanting to stall. It's also probably why it took us this long to get green numbers, i was doing horrible with keeping to the 12 hour schedule. I do have three little beans now so it's quite hectic here!
Click to expand...
see how things go. it won't take you long to pick up on sparky's response on lantus. once you're comfortable, you'll pretty much want to shoot anything over 50.
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49 +4 50

I don't understand why you would shoot at a low number and follow the insulin with carbs and karo. Why not just stall the shot for a few hours?
Click to expand...

You make a very good point; however, my Gracie just keeps dropping instead of coming back up within the two hours that I can stall. I don't like skipping shots as she skyrockets and spends more time at high numbers than I want. I typically do not use any food over 8%..10% max with her. Those are considered LC. If I have to use gravy, I use 13%..a medium carb. I do have to use karo with Gracie....we've tried not to. But she "accumulates" her carbs....in other words, she doesn't come right up. It sometimes takes a couple hours and if I need her up quickly, I have no choice but to use karo. We've tried so many different things, it would make your head spin :-D :-D

What I usually try to do is monitor her PRIOR to PS and if I see her sliding down towards a low PS, I feed her LC food no later than +10. That usually helps. But not always. LIke Jill said, it's ECID and know thy cat.
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49 +4 50

ps ------ take a look at alex's 2009 ss (click on the 2009 tab at the top of her current ss).
i purposely tested her a lot in order to use her ss as a tool to show what happens when you shoot full doses on low preshot numbers... how to obtain the long shallow curves lantus and levemir are known for.
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49 +4 50

@Marjorie: That does make more sense then. I stay under 8% carbs too. THough my BF was feeding him ones that were 15-20% for a while, that's when the honeymoon ended. And why I'm being so aggressive now, i'm hoping the move back to our regular diet and some kickstarting with insulin will put us back on track.

@Jill: 3rd honeymoon's the charm? I was just looking at your SS- you're braver than me sometimes! Great numbers though, even with Alex's other issues there.
 
Re: 9/4 Sparky PMPS 65 +1 57 +2.5 49 +4 50

And Jill, you've been at TR before 2007. I just peeked at my old Remission Survey (remember that?), and that was in 2006!
 
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