AMPS 5.3/95, +12 4.1/74 ALPHATRAK - Advice Needed

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Critter Mom

Critter Mom

Member Since 2014
Hi all,

Saoirse's numbers were trending upwards in the afternoons so yesterday and today I gave her a morning dose of 0.1 IU Lantus (the drop that you squeeze out when the plunger is right at the bottom of the barrel of the syringe). Also, today Saoirse had an ultra low carb food (<1% calories from carbs).

After the low at AM+12, I fed Saoirse some 4.4% carb food and at AM+13 (PM+1 on Saoirse's SS) her BG was back up to 5.7 / 103. Saoirse's clinical signs are fine at the moment. She is alert and will play with her favourite toy.

I am concerned because her BG runs lower at night. I am monitoring her closely. I plan to check her again at AM+14. I know that I need to have 2 consecutive stable/rising numbers, but I'm not sure how to tell if they're not influenced by food. During the night, Saoirse normally has her mini meals 2 hours apart.

Also, does the 4.1 / 74 reading mean that a dose reduction would be earned, and is Saoirse ready for an OTJ trial?



BG Summary - Measured on ALPHATRAK:

AMPS - 5.3 / 95
AM+7 - 5.4 / 97
AM+8 - 4.9 / 88 (c. 1 hr after food)
AM+12 - 4.1 / 74 (2.75 hrs after <1% carb meal) - fed 20g 4.4% calories from carbs.
AM+13 - 5.7 / 103 (1 hr after food)
AM+14 - 5.6 / 101 (2 hrs after food) - about to feed another mini meal.


If you are looking at Saoirse's spreadsheet, numbers are available in both international and US values (brief log pages are easiest to parse). The colour ranges are customised for the Alphatrak meter. Please refer to the key in the header rows for the range thresholds.

I would be grateful for help and advice.
 
Aine
alot more people are usually on line at night on the TR board. i don't have enough experience to advise you and since you have a 911 i would suggest you copy this post and also post it on the TR board. they usually have people monitoring for 911 all the time. just in case no comes on line here.
 
Thanks for replying, Obie. In answer to your question, Saoirse was very, very close to the hypo threshold.
 
Table updated.


BG Summary - Measured on ALPHATRAK:

AMPS - 5.3 / 95
AM+7 - 5.4 / 97
AM+8 - 4.9 / 88 (c. 1 hr after food)
AM+12 - 4.1 / 74 (2.75 hrs after <1% carb meal) - fed 20g 4.4% calories from carbs.
AM+13 - 5.7 / 103 (1 hr after food)
AM+14 - 5.6 / 101 (2 hrs after food) - food not given yet - clinical signs monitored closely.
AM+15 - 6.0 / 108 (3 hrs after food) - fed 12g 4.4% carb food just after this test.
 
Hi Crittermom!

Below 68 is what we consider too low on the Alpha so you were close, but doing OK (I understand using the "relaxed" protocol, they say higher, but above 68 is still a "safe" number)

I haven't had time to go back and look at all your condo's, but I'm not sure why you started back on Lantus .....getting one or two numbers higher than "Normal" usually isn't reason to worry when you're doing the OTJ trial...we suggest trying to feed a little at +9 to see if you can bring that Pre-shot down a little

I think it's time to go back on trial!!

Since she's coming up now, and you didn't shoot tonight, I'd just get another test 2 hours after the last time she got food and if she's still doing OK, you're past the point where you'd need to worry

Edited to add....we consider 50-120 on a human meter to be normal....so on the AT that would be 68- to up to about 150...and she's stayed below that consistently. I think she's doing great and is tired of this sugardance!
 
For those following the TR protocol, reductions are earned on the AlphaTrak when you go below 68 (2.8). We have seen several OTJ cats or non diabetic cats whose normal readings are in the 54-68 (2.2-2.8) range on the AT (40-50 for human meters), but we suggest reductions below 68 because it gives little margin for error when on insulin.
 
Hi Chris and Wendy,

Thank you both so much for responding and for all the clarifications and advice. I was nervous about the low, and doubly nervous because Saoirse tends to dip in the hours before breakfast time(shows in her bearing and behaviour even on nights when I don't test).

Wendy, thank you for the clarification about the criterion for dose reduction.

Chris & China said:
... I'm not sure why you started back on Lantus .....getting one or two numbers higher than "Normal" usually isn't reason to worry when you're doing the OTJ trial ...
Click to expand...
The last time Saoirse went low, Marje and Julie had a look at her numbers. Because I hadn't gone to the 0.1 dose before starting her OTJ trial they thought it was possible some depot insulin might be holding down her numbers. Both suggested giving the token doses to increase the possibility of a strong remission, especially if Saoirse's numbers started to drift upwards (which they did). I've identified that Saoirse's BG spikes when she has fasted for too long. I'm continuing her cyproheptadine alongside her ondansetron to help with that.

Chris & China said:
Since she's coming up now, and you didn't shoot tonight, I'd just get another test 2 hours after the last time she got food and if she's still doing OK, you're past the point where you'd need to worry
Click to expand...
Thanks for the reassurance that the dose should be wearing off soon. That's what I was most worried about (petrified I'd pass out due to PTSD-related fatigue - eyes are out on stalks at the moment).

Chris & China said:
Edited to add....we consider 50-120 on a human meter to be normal....so on the AT that would be 68- to up to about 150...and she's stayed below that consistently. I think she's doing great and is tired of this sugardance!
Click to expand...
Thank you for that oh-so-welcome reassurance. Fingers and paws crossed that she'll stay that way ... will restart her OTJ trial countdown again in the morning.
 
. I've identified that Saoirse's BG spikes when she has fasted for too long.
Click to expand...

You might try feeding her at +9 (I know that usually means about 3am in the morning or some other un-Godly hour) but a lot of times we see a little snack at +9 can help pull those Pre-shot numbers down because it stimulates the pancreas into releasing a little insulin

Now that the emergency is over, please go ahead and take down the 911 so we don't give anyone else a heart attack ;-)
 
Table updated and timed feeders loaded to make sure Saoirse has food on the hour for the next few hours. Thanks again, Chris and Wendy, for helping us through the night.

One final question: is it possible that Saoirse's BG may be a bit higher for the next few days because of tonight's low?



BG Summary - Measured on ALPHATRAK:

AMPS - 5.3 / 95
AM+7 - 5.4 / 97
AM+8 - 4.9 / 88 (c. 1 hr after food)
AM+12 - 4.1 / 74 (2.75 hrs after <1% carb meal) - fed 20g 4.4% calories from carbs.
AM+13 - 5.7 / 103 (1 hr after food)
AM+14 - 5.6 / 101 (2 hrs after food) - food not given yet - clinical signs monitored closely.
AM+15 - 6.0 / 108 (3 hrs after food) - fed 12g 4.4% carb food just after this test.
AM+16 - 6.3 / 113 (1 hr after food)
AM+17.5 - 6.2 / 112 (2.5 hrs after food) - fed 16g 4.4% carb food just after this test.
 
As well as she's doing, I wouldn't expect her to bounce very much

If she's over 150 in the morning, you could go ahead and give the .1 again if you are going to be home to monitor to get her over the "bump", but I think she'll do fine either way
 
i kinda doubt this will have an effect after the cycle is over, but you never know. Just watch and see. The reason I'm doubting is because I don't think it was low enough to trigger her liver to react.

just to clarify, we differentiate between low numbers and a hypo. Often cats on Lantus will have low numbers, under 50/68AT but no symptoms. that's ok - you just want to give some carbs to pull them up. that's not dangerous yet, just time for you to take action and steer her back up above 68.

a cat that has low numbers + symptoms is having hypoglycemia. that's an emergency.

just wanted to throw that out there for the future.

I'd encourage you to feed her small meals around the clock - that's easier on a healing pancreas. that likely will help bring down some of the higher numbers as well. I think i'd play this by ear and just see how she is tomorrow.
 
Looks like both Nadine and I had to look that one up...lol Actually I was pretty sure I knew the meaning just hadn't heard the phase in years. Is everything okay? I really didn't think I was contagious over the internet. :sad:

Mel and The Fur Gang
 
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