AMPS and PMPS both in 300, Nadir still 80-90. Up dose?!

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cellosmom

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PMPS - 309-----1-1.25U
+6 - 85
AMPS - 354-----1-1.25U

I am home this Saturday, so I was thinking of upping Cello's dose during the day shot (I tried to give him 2 shots at 1.25U, but I am having trouble I think actually measuring THAT little, so it's probably still closer to 1)

I was thinking of trying at least 1.5U since I'll be home to curve him. Try to get his numbers to stay lower longer, they are consistently shooting back up to the 300's now PS.

I think I need to be more aggressive and start a scale of some sort with him perhaps, but I'm really not sure.

Thoughts?
 
That is a huge drop. The problem is needing lower pre shots to match. He could be bouncing from the preshot down and back up again and a higher dose can make that worse. Let's see if he levels out a little.

I saw your post on Health. Glad there are others in your boat to give you some support. Nadirs are great but with your sleep issues, you might substitute some earlier and later numbers in the cycle. For instance, get an earlier number right as you walk out the door for work. And a number as you walk in the door. Then some numbers before you go to bed but after the shot. All data helps.
 
Personally, I think that 85 is a really good nadir. If you are shooting 1 unit and you increase to 1.5..you are talking about a 50 percent increase---I think that is a lot with an 85 nadir. And, if we are honest....we really don't know if the 85 is the nadir---even though it is your +6 reading, and probably your nadir....it might not be...he could have gone lower. I think your preshots are more of a bounce and I would not increase the dose. If they are a bounce, he will get use to the greens and will settle down. You really have to be careful when you base your dosing on preshots. ....remember, prozinc is in and out of the body in 12 hours, so it is to be expected to see spikes at the beginning and end of the cycles.

Just my opinion....but, I would not increase...I would let the dose settle in....

Are you using U40 syrninges?
 
U 100 syringes for now. going to buy the ones with the 1/2 marks next timer ound.

Thanks for the advise.

I do have a question about it being in and out of the body in 12 hours......

When I started (before I came here) and i was dosing high (2-3U based on TR) notably he did drop low (30-40...not ideal, but luckily no hypo symptoms) but he would stay in the greens for hours after +12, you can see it on the spreadsheet....... Why would this be if the insulin is only in the system for 12 hours?
 
That does happen with too much insulin. It can last longer. (not sure why in scientific terms- just know it can). But it isn't something you want.
 
Sue and Oliver (GA) said:
That does happen with too much insulin. It can last longer. (not sure why in scientific terms- just know it can). But it isn't something you want.
Click to expand...

Ok :) thanks.

I'll keep with the steady dosing and hope for the best....... just a bit impatient to see improvement. Doesn't seem like he is even technically "regulated" at this point, let alone well regulated or tightly regulated.

But he is symptom free (only symptom had been excessive drinking/urination) and I guess that is what is important
 
Yes, sometimes when there is too much insulin it will "hang around" longer. But, ideally it should be in and out in 12 hours. I will admit that even with my cat Kitty, if I give more insulin she seems to stay lower longer....BUT, I am not in green numbers, so the increase does not concern me.

He really might be doing "better" than you think. Once he accepts the lower BGs the bouncing should decrease and hopefully, he will settle down. I have seen many kitties here that start with numbers like you have and gradually their preshots will come down. You might want to check out Asher's SS....he comes to mind to me....and I might be off base, but he has steadily adjusted and is now in really nice numbers.

Remember......it is a marathon not a sprint!!!

Good Luck!
 
JUST TO BE CLEAR: Rebound/Bounce is his liver putting out glucose because his body isn't used to the low BG that insulin causes? This is totally possible because he got diagnosed in August, I'd noticed the symptoms in Late July, and didn't start insulin until October because I was literally gone the entire month of september and there was no way I could start insulin and leave for work. So maybe because he had high BG for a few months his body is used to it?

Does that make sense?
 
Rebound is a really hard concept for me to get my head around. Maybe this will help: Rebound I think there is a difference between rebound and bouncing, but I have never been able to understand the difference. Maybe it's that bouncing is faster reaction to a low number?
 
The two terms are tossed around a lot, and sometimes interchangeably.

Here's what I think the difference is:

"Bounce" is usually a one-time thing. BG goes too low, and the liver dumps glucogon (sp?) into the bloodstream in an attempt to ward off "low" BG. The BG doesn't have to be low by our standards. The kitty is just so used to living with higher BG that the body instinctively dumps sugar. Also called "liver panic" (which we all know can be fought off by "Prozanc") :lol:

"Rebound" is usually something that recurs, and can last longer. Sort of like a perpetual bounce. It is usually due to a dose that is too high, where "bouncing" isn't necessarily caused by a too high dose. The patterns in a rebound aren't as simple as those in a bounce.

A bounce is usually shown by a deep smiley curve, and results in an unexpectedly high PS reading at the next test. They will usually clear within a day or two at most, as long as you don't "shoot the bounce" - mistakenly think that the insulin needs to be raised because the numbers have climbed. So you need to make believe the bounce didn't happen, and shoot a dose equal to the previous dose, or just a bit lower even. Kitty's body will learn that the "too low" BG around mid-cycle wasn't really "too low", and the liver action stops. "Shooting the bounce" by raising the dose can easily turn the bounce into a rebound.

Rebound, on the other hand, would require reducing the dose, or it will not go away. Cycles can show the same or higher PS results, but the curves will be flatter or inverse shaped - what I like to call a "Frown" shaped curve. They make us sad. ;-)

Those may not be the universal definitions, but that's what I am saying when I comment that a bounce or a rebound seems to be happening. Bounces are almost guaranteed to happen once in a while, because livers are prone to panic. A bounce is a "little" problem. Rebound is a bigger problem and harder to get past.

Carl
 
I think rebound and bounce are the same, though I'm not sure everyone uses them the same way. Here's what I see:

There can be "real" causes and "perceived" causes (liver training). From what I have read, rebound can be acute (one time), or chronic (repeated acutes that leave their body in a constant fighting stance, so you get high flat numbers ongoing).

"Real" rebound is from actual low numbers or steep drops.

Liver training rebound is when they get safe numbers that they are not used to, and their body reacts to it as if the numbers are unsafe.

Liver training would never get to a chronic pattern though, as it goes away on its own as they spend more time in good numbers. So liver training is only acutes, real rebound can be either acute or chronic.

I really wish we had 2 separate terms for them, it is just such a confusing mess whenever it comes up. Maybe some are trying to do that with bounce vs. rebound? I'm not sure. I read them as the same - a rebound/bounce response. Then it's the puzzle to figure out is this real rebound (meaning the dose is too high), or liver training rebound (where you want to hold the dose).

I think those nadirs are great and you wouldn't want a steeper drop, so I would not increase the BID dose. If you wanted steadier lower numbers, I would consider shooting earlier, either TID, or something like shooting at +10s, or as needed shooting (picking a threshold like 150 and going ahead with another shot as long as they are past nadir and rising again). Any of those might require dose reductions, you would not necessarily shoot the full BID dose on an early shot (you probably already know that, just mentioning it for clarity for any newbies reading along).

When they stay in greens to +12 or longer, it can be too much insulin, or it can also be a sputtering pancreas. Hard to tell which. To some extent you can guess if they shoot up really fast at a point like +14 and go from greens way up to reds or so in an hour, that is the insulin wearing off. If they gradually drift up more slowly (like Bix sometimes used to go 24 hours or longer before he hit something like 150 or 180 to give a shot) and don't zoom suddenly, that's possible pancreas sputtering. Not hard & fast rules, just some thoughts.

I think it would be fine to stay where you are for a bit since you are seeing good nadirs, or I think it would be fine to try some version of early shooting if you are feeling impatient. Nothing wrong with doing that as long as you do it safely by regular testing for early cycle numbers and nadirs, hypo toolkit on hand, and adjust the dose as needed based on what kind of overlap you may see with early shots. It's up to you really what strategy you want to take, how your schedule is, etc. etc.

When I got impatient and tried early shooting I really didn't get anywhere and I think it slowed us down (Bix got good duration so it turned out he didn't really need it, plus I tended to overreduce the dose). but I've seen others make good progress that way. Sometimes even doing early shots as going for TR over a weekend or something can help promote pancreas healing and then you can go back to BID during the week and get better results. If you can get the dose right and get good numbers that can be a good strategy.

That is great he is symptom free! YAY!
 
cellosmom said:
So maybe because he had high BG for a few months his body is used to it?
Click to expand...

from what I have read in the Wiki, 3-5 days in the reds will set up temporary insulin resistance, so if you can infer from that there would be other signs of their body getting used to the higher numbers, it would seem like most cats will likely go through liver training to get re-used to the better numbers... I think it's typical that they are high for a few months before we peeps are wise to the symptoms... and who knows how long they may have ridden somewhere like yellows or pinks, probably wouldn't see huge symptoms yet at that point, right? I know my kitty was in reds or blacks when diagnosed, I'm sure that didn't happen overnight. Poor kitties! :YMSIGH:
 
Joanna,
I know with Bob, it was probably at least a month of excessive peeing before I finally took him in. Honest truth, we were mystified at what was wrong with the LITTER!!??? I swear, we started noticing his feet full of clay, and all we could think was "they must have changed the litter formula". So every week, we're going to the store trying another and another brand. Even the "World's Best Cat Litter" was faulty!
It was like when our infant daughter started crying at about a week old. Doc said "must be the formula". We tried every one on the market before a third or fourth opinion said "She's got colic" After 3 months, he said "that's the worst case of colic I've ever seen!". At 6 months, she finally went a day without crying. Good times! Now she's 25 and I still remember it like a bad nightmare. :smile:

Anyway, it wasn't until Bob got so bad that he was obviously skinny (well, skinnier) and so dehydrated that the fluids in his joints dried up so much that he howled for 36 hours every few minutes (flash back to colic) that I brought him in. Yeah, black numbers and DKA. He's also lost 6 lbs in 6 months, and most of that was probably in the last of those 6 months. Damn litter manufacturers!
Carl
 
Thanks guys...... I'm going to hang tough. Keep it up with the 1U BID, I don't think it will be work well with my life to go TIB. He had a good night tonight, in the blue-yellows pre-shot (shot late to make sure he was rising). I appreciate the advise and support. Glad I'm not the only one who took so long to get Cello to the vet and start insulin. Luckily he never lost weight or had any other symptoms. He is doing great tonight :)
 
Until my vet walked in the room and said "Bob is diabetic", I had no idea that was even a possibility for cats.
I had seen dogs with diabetes, but had never heard of a cat with it.
Carl
 
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