Advice please?

Status
Not open for further replies.
emchic

emchic

Member Since 2012
I'm posting here because I need some advice from you guys who are much more knowledgeable about BG and Lantus than I am. Zoozey is recovering from a near death experience with DKA. For the past couple of weeks he's had beautiful AMPS and PMPS readings, all in the 100s, and the curve I did at home a few weeks ago gave similar readings as well, so I thought he was beginning to stabilize. But this morning his reading was 355. He ate with enthusiasm, I gave him 1.5u of Lantus, and we played for a while. I checked his bg at 11:30, and it's gone down to 291. Other than the fact I've been home a bit more since the semester ended last week, (which all three of them love), nothing has changed. If Zoozey is eating, grooming, looking out the window, and playing, I can only assume that he's feeling pretty good. Is it normal to have a bunch of the readings in the 100s in a row and then have a high one? He's about a month out from his DKA. Is this something that just happens sometimes? I would give pretty much anything for him to never to be in DKA ever again. Fortunately, I'm able to be at home today, so I'm going to check him again at 1:30. Any advice or wisdom you guys would have to offer would be greatly appreciated. Also, I have a spreadsheet linked in my signature with every reading I've done on him since he went on insulin.
 
There are a couple of observations...

The True2Go meter that you were using tends to be pretty unreliable. While some sources like the meter, people here have had a pretty consistently bad experience. It's great that you were able to switch to the NovaMax. It's possible that the difference you're seeing is due to using a better meter that's giving you more accurate results.

I would not encourage you to base any conclusions on having only pre-shot test data. Lantus dosing is based on the nadir values. You need to ideally be getting at least 4 tests per day -- your pre-shot tests and at least one test during each cycle. Getting an in and out of the house test, a before bed test, etc. on a daily basis is very important. If you're at school all day, then you really need to get PM tests. Many cats run in lower numbers at night.

The high pre-shot today looks like Zoozy may have eaten something with higher carbs than usual. Alternatively, Zoozy's numbers may have dropped into lower ranges last night and you're now seeing a bounce into high numbers. There's just no way to draw any conclusions without more information.

Having had a cat that survived DKA, I'd also recommend that you test for ketones whenever you can. If you're not already testing for urinary ketones with Ketostix, I'd encourage you to do so. It's the best early warning system money can buy.
 
I wasn't thrilled with the True2Go meter, but at the time I needed a meter asap, and I didn't have very much money. I orderd the Nova Max right away, but I just got it last week. I was interested because it tests for ketones. I checked his ketones just now using the NovaMax meter and I got an LO result, which the instruction book says is a reading less than .01mmo/L

I did drop some tortilla chip fragments on the floor yesterday. I cleaned them up as soon as it happened, but I perhaps I missed a fragment or two and he ate those. Other than that, there is absolutely no food out except for what I feed them. I'll keep checking him today, and as far into the night as I can.
 
Okay, it sounds like you've rules higher carbed food being the reason for the high numbers. I think I agree with what Sienne said about the possibility that a low number overnight is most likely the cause.
Look back on the AM cycle on 11/21, where you saw the drop down into the 40-50 range. Although you didn't see an immediate "bounce" from those low numbers, the same sort of thing may have happened again on the PM cycle that night. The next day, the numbers were much higher, but eventually they got back under the 200 level. For the last 10 days, all of the preshot numbers have been in the blues. Like Sienne said, the missing piece of the puzzle is what is happening between those shots. How low does he go? The reason that is so important is because those are the numbers that you would use to know whether or not the dose needs to be adjusted (up or down).
My gut says "down", because I think there a good chance you might have had a low number last night, and no telling if/when he might have dropped under 50 (when that happens, it means a reduction in dose is needed).
It could have something to do with the two different meters, but you made notes on the 7th saying that the nova max read 120 while the True2Go read 149. That's not THAT much of a difference if you consider either meter can be off by 20%.
Normally, when I see a number like your AMPS today, I suggest retesting right away, because the number sticks out like a sore thumb compared to all those blue numbers. But your test at +4 tells me that both numbers are probably accurate.
I would be inclined to believe that today's cycle is a "bounce" and that his BG last night was probably low. It can take a day or two (ECID) for a bounce to clear, so you may see yellows or pinks for a couple more cycles. If so, don't freak out, because if it is due to bouncing, it'll clear and he'll get back down to nicer numbers. In the meantime, try your best to get a test or two in between shots, to try and figure out how low he goes. Then you'll be able to know if the dose is in need of adjustment.
And great on the no-ketones! Definitely something you want to test for given his DKA history.

Carl
 
I'd tend to agree on the bounce theory. It really is important to try to get mid cycle tests in. Now that you are on break I hope you can work that out.

The Tru ToGo meter was my first meter too. The lower numbers weren't too bad, but over 200 it was way off from other meters. I'd stick to the NovaMax, if the strips are too expensive check out eBay. I can often get my strips for less than $10 a box including shipping. Just look out for expiration dates in the description.
 
Carl, or anyone, could you explain to me exactly what a bounce is? I know it has something to do with bg readings, but not much other than that.
 
I'm sure someone will come along with a more scientific and precise explanation, but basically a bounce typically follows after a cat has gone into lower numbers that its not used to. The liver freaks out and tries to save the day by producing it's own special brand of "sugar" called glucogen which pushes the numbers higher. Some kitties bounce real high, and others bounce somewhat mildly. It can take a cycle or sometimes two for the numbers to come back down to the "normal range" for the cat. You'll see lots of people talk about it - check out their spreadsheets and you'll see what they mean.

Keep collecting data! You're doing great!
 
Thank you! I'm going to check his numbers as much as I can after his PM shot to see where he's at. Do bounces just sometimes happen? He's definitely not stressed out, and unless he's found some tiny portion of some sort of high carb food on the floor that I somehow missed, he's not had access to anything but his cat food.
 
Well, bounces should be a reaction to a lower number and they are quite common, quite normal and can be very frustrating. You should be sure you have some good strong "patience pants" in your possession. I think there might be a sale on at Target for Christmas!!! :lol: Once you get more data you'll be able to pretty much predict them, or at least maintain some sanity if you can recognize them and realize they will pass. I can't imagine any tiny crumbs of tortilla chips (om nom nom) would cause a big spike in the numbers unless Zoozey is very carb sensitive. Even if that were the case, that too shall pass. A bounce is a more likely scenario, as has been proposed.

Hang in there! Sounds like you might become a poke-aholic like me! haha_smiley
 
Barbi, I'm sorry,
I figured you'd already heard "Bouncing 101" :smile:
Very simply...
A cat's body gets used to higher BG numbers when they get diabetes. Zoozey's "normal" as far as blood glucose goes isn't "normal", but it is to him. The pancreas's primary function, as far as blood glucose levels goes, is to regulate them by supplying insulin to keep it in the normal range all day long. Because he's diabetic, his pancreas isn't doing that part of it's job, so you're having to play the part of his pancreas by giving him insulin.

What tends to happen is that when the BG drops, either too fast, or too much, is that his pancreas starts a chain reaction, which ends up triggering his liver to dump "sugar" into his blood. It's purely instinctive, and the intent is to stop the BG from going "dangerously" low. I put that in quotes because it doesn't necessarily mean that it's really dangerous. His body thinks it is, because it's so much lower than what it's used to. It can happen when the level drops from 400 to 200, or it can happen if he drops from 100 to 50. There's no set rules for what will trigger a bounce.

So his liver does this, and usually it overreacts. That causes the BG to go a lot higher than it needs to in order to keep him "safe" from hypoglycemia, but once it happens, it happens. The BG will go into the much higher than normal range. We call this "bouncing" for lack of a better word. Don't know where it comes from, maybe it goes back to Tigger?


The important things to remember are:
-They're instinctive and they happen to every cat.
-They go away, or "clear" on their own, and this can happen quickly (hours later), or sometimes they might last a couple of days.
-As time goes by, Zoozey will get used to lower numbers again. And as he does, the bounces won't happen as often. The term used here is "liver training school". The more lows his liver sees, the more used to them he gets.
-They're not all "bad". It means his pancreas and his liver are doing what they are supposed to do, at least to some degree.

Hope that makes it a little more clear?

Keep asking questions!
Carl
 

Attachments

  • tigger.gif
    tigger.gif
    7.9 KB · Views: 584
Thank you Carl and Tara, that does help. I've been doing everything I can to help him get well, and I was a bit concerned when I saw that high number this morning, particularly since we're traveling next weekend, something that typically stresses him out. I'm expecting to get some higher numbers next week when we hit the road, so my big concern is that he'll get really really high numbers on top of the high numbers he's having right now. I'm making preparations to alleviate his stress level as much as possible, but I know I can't avoid stress completely.
His PMPS went up a bit, to 328, but he felt good enough to make me chase him when he saw me coming with the bg meter, and he's in my kitchen right now chowing down on his dinner like a boss. I have to teach really early one last time tomorrow, so I won't be able to do a 4+(unless I have insomnia again), but I will definitely do a 2+ check and after tonight, I'll be able to do more PM bg checks.
Thank you guys for answering all of my questions. I just want to know everything I can so that he can be as happy and healthy as possible. And you're right Tara, I probably will become a poke-a-holic! It's getting easier and easier for me to check him (unfortunately he doesn't like it any better, but we both deal with it), and this new meter makes it so much easier with the smaller blood sample.
 
Hi...just stopping in to say "Welcome to LL!" You've gotten lots of answers on bounces and such. I did see in Zoozeys profile that you've been feeding m/d and w/d. Despite their "prescription status", those are actually a bit high on the carbs.

Here's a link to Dr Lisa's food chart...she breaks down carbs, calories, phosphorous, etc. of many many foods. It's a huge help, and there are lots of great options that are lower in carbs (and in price!!!)

Dr Lisa's Food Chart

Again, welcome to Lantus Land...keep asking questions!!
 
Good catch Amy, the Hills W/D is 25% carbs and the M/D is 14%. Are you still feeding it? if you are and change to an LC food it will probably mean that he will need a dose decrease too. They can drop suddenly when the food is changed.
 
I think it's good you are going to try and get more tests. If you notice, his PMPS are lower than his AMPS and many cats go lower at night.

A typical lantus cycle looks like this :
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
Click to expand...

If the +2 test is much higher than the PS, it's likely to be a quiet cycle. If it is similar to the PS, you should expect an active, typical lantus cycle. If it is much less than the PS, you should expect a very active cycle with perhaps an early drop.

Please let us know your questions and how we can help?
 
Marje, what's the difference between an active and a quiet cycle? Are the numbers all over the place in an active cycle? Much to my annoyance, I got an error reading this morning--and it was my last test strip. I'm going to pick up some on my way home today. Will it be useful to test him this afternoon if I wasn't able to get an AMPS reading? I'll definitely test to at least to the 4+ on his PM cycle, and I'll do a 6+ test if insomnia strikes again.
 
I'm sorry to just get to you....I'm usually on later in the day.

An active cycle looks like the typical lantus curve; a very active cycle is one where they come down fast early on. During an active cycle, you'll see numbers going down to nadir and then coming back up towards the end of the cycle. If his numbers are wobbling up and down at fairly high levels, that isn't an active cycle.

Most of us keep at least 100 strips on hand. The last thing you want is to have him throw you a low number at ten oclock at night and you have no strips and have to find a place open. It's happened and it's not pretty. I actually keep 200 strips at a minimum on hand. You also need to be careful about shooting without a PS test. We don't recommend shooting "blind" here. I've had Gracie be at 200 at my last test of the night and then be at 40 something at AMPS. We do not recommend that even experienced members shoot below 50.

I would definitely get a test before his PMPS if you can....you don't want any surprises.

We suggest when you start out to get the PS, +3, +6, +9 and you can also switch off the next cycle or so and get a +2, +4, +6 and +10. Once he starts showing some progress, you want a +2 for as many cycles as you can; when Gracie was on lantus, I always got a +2 for reasons I stated above.
 
Yeah, I was really annoyed about being down to my last strip. Unfortunately, it was a matter of money. But I got paid yesterday, so I'm stocking up right now so that this doesn't happen again.

Today, I got an AMPS and +4 reading thus far. +6 will be in about a half hour, and I will be taking another reading. His numbers are coming down a little, but he's had diarrhea twice this morning (after I took the +4 reading). He's ate well this morning (DM savory selects, which he's not had a problem with before), he's played some, and he's wandering around this morning. Should I be concerned with the diarrhea?
 
We'd really like it if you could please do a daily condo for him like we all do. That way, your questions, etc, don't get lost. Here's a great condo on how to Make the Most of your Lantus ISG Experience. Also, you can ask if there is anything in there that isn't clear. With many members to track, if we see a running synopsis of his numbers in the subject line as the other members do, we can pop in and let you know if we think anything is amiss.

If you have nonFD related questions, you can still put them in the same condo or thread and add the question to the subject line. You could put:

12/15 Zoozey AMPS 241 +2 211 Diarrhea??

Someone will pop in. You can also use the question icon above the subject line and it will mark the thread for us to pop in.

Glad you got the test strips. With him having had DKA, you must keep getting insulin into him but shooting blindly can also be a risk.

I'm not familiar with DM Savory Selects. Is that a Prescription Diet food? Most of us do not feed any of the DM prescription diet products. They have horrible ingredients and aren't that low in carbs. We typically choose foods from Dr. Lisa's Food Charts. You want to select LC foods (less than 10% calories from carbs and many of us select in the 4-7% range). You also want to have some MC and HC foods on hand in case he gets low and you need to bring him up.
 
Status
Not open for further replies.
Back
Top