Angel diving lower and lower

And for the regular spreadsheet updates: another AMPS low! 3.9 this time. So a skip today and another reduction tomorrow. Maybe I should do a +8 test as well... I figured we were safe with 6.6 at +6 just like the last few days, but she clearly dropped lower which was unexpected.

I don't like the pink from yesterday, but I think that was just because I was so nervous about using a new vial for the very first time, especially at night, that I only shot a token dose when she was already in the yellow. Seems I was right to worry though, seeing how she dropped 16+ mmol/l this cycle on a full dose. I worry a lot about her going too low while I'm asleep and unaware.
 
This is NOT a dosing advice, as I am inexperienced with ProZinc (we are on Lantus) just an observation, which I'm sure a lot of, more experienced members will perhaps disagree with:
Seeing how her PMPSes are often in the same range, and her AMPSes are low/often the lowest - could it be that she'd benefit from a QD dosing instead of a BID?

I understand the mechanics of insulin absorption/metabolism, thus why the BID distribution works best for most cats (emphasis is on most). However, I heard it from other owners as well as from vets when talking about the use of ProZinc in particular, that sometimes a once-a-day administration of it is enough, because after all, it all comes down to the individual cat's metabolism.

I wonder what pattern would she have shown keeping her at 3.5 IU QD. Whether she would have stayed yellow both PMPSes, in blues throughout each side of a 24hr cycle, that would gradually turn into greens closer to "nadir" which perhaps falls on the 12th hour aka AMPS. Something like this:
PMPS +1 +2 [...] +11 AMPS +1 +2 [...] +11 PMPS
beginning of cycle ---- nadir ---- end of 24hr cycle

I understand she dropped low on that 4 IU in the PM cycle a few days ago, however, I noticed on my cat, that after a delay and/or even the slightest dose increase, his body would panic and his BG would hit nadir sometimes as shockingly early as +2/+3 of the cycle, as opposed to his usual +5/+6/+7. (Hence why the protocols are written the way they are, because their little bodies need time to adjust to a certain dose, to see its full, evenly distributed potential. It is not to say that 4 IU was a good dose. It was definitely too high for her, and the reduction was earned. It is to point out a reoccurring pattern I observed on my own cat, that may be relevant to yours, too.)
So if my theory of a 24hr cycle for Angel would be applicable, and if my math is mathing correctly, that +2/+3 nadir "shock drop" after delay/increase would fall right to those times where Angel went low at +7/+8.

Does it make any sense?

Again, these are just my observations and the inputs I have encountered from vets and other ProZinc users. I may be completely wrong, and I'd urge you to perhaps discuss this with more experienced members and/or your vet. I just wanted to share my thoughts after looking at your spreadsheet, because I know from experience that we can get very accustomed seeing our own sheets day in and day out, that we may overlook certain patterns that perhaps stand out to others.
 
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.:. in.active .:. said:
This is NOT a dosing advice, as I am inexperienced with ProZinc (we are on Lantus) just an observation, which I'm sure a lot of, more experienced members will perhaps disagree with:
Seeing how her PMPSes are often in the same range, and her AMPSes are low/often the lowest - could it be that she'd benefit from a QD dosing instead of a BID?

I understand the mechanics of insulin absorption/metabolism, thus why the BID distribution works best for most cats (emphasis is on most). However, I heard it from other owners as well as from vets when talking about the use of ProZinc in particular, that sometimes a once-a-day administration of it is enough, because after all, it all comes down to the individual cat's metabolism.

I wonder what pattern would she have shown keeping her at 3.5 IU QD. Whether she would have stayed yellow both PMPSes, in blues throughout each side of a 24hr cycle, that would gradually turn into greens closer to "nadir" which perhaps falls on the 12th hour aka AMPS. Something like this:
PMPS +1 +2 [...] +11 AMPS +1 +2 [...] +11 PMPS
beginning of cycle ---- nadir ---- end of 24hr cycle

I understand she dropped low on that 4 IU in the PM cycle a few days ago, however, I noticed on my cat, that after a delay and/or even the slightest dose increase, his body would panic and his BG would hit nadir sometimes as shockingly early as +2/+3 of the cycle, as opposed to his usual +5/+6/+7. (Hence why the protocols are written the way they are, because their little bodies need time to adjust to a certain dose, to see its full, evenly distributed potential. It is not to say that 4 IU was a good dose. It was definitely too high for her, and the reduction was earned. It is to point out a reoccurring pattern I observed on my own cat, that may be relevant to yours, too.)
So if my theory of a 24hr cycle for Angel would be applicable, and if my math is mathing correctly, that +2/+3 nadir "shock drop" after delay/increase would fall right to those times where Angel went low at +7/+8.

Does it make any sense?

Again, these are just my observations and the inputs I have encountered from vets and other ProZinc users. I may be completely wrong, and I'd urge you to perhaps discuss this with more experienced members and/or your vet. I just wanted to share my thoughts after looking at your spreadsheet, because I know from experience that we can get very accustomed seeing our own sheets day in and day out, that we may overlook certain patterns that perhaps stand out to others.
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I'm not sure, I think I'm not experienced enough for this either. I'll discuss it with my vet, and if any members on here want to weigh in, please feel free.

Given that she just had another low/hypo on just 3U, I don't think we can/should increase anyways. I am skipping or shooting reduced doses at AM often, and sometimes it's high after that sometimes it's not. I think we'll just keep doing what we've been doing so far; it seems to be working out well. She's earned another reduction down to 2.75 next shot.
 
Anyways, I thought I'd do a +8 today to see how low she'll go. At 3.1, that's too low once again!

I'm guessing AMPS will be low again, probably either a skip or a reduced dose. She seemed to do well on the 1.5U I shot last AMPS. And then we'll shoot 2.75U the next time she can have a full dose.

Hoping we can achieve the fabled Remission; she certainly seems determined to keep going down and down. Is that even possible while still on high carb food?
 
3.1 is not too low on a human meter. But 2.6 is. But look at her go, earning all these reductions! ;)

BTW some cats do well in lower numbers, not to mention they are great at masking, so sometimes their hypo is asymptomatic. Such a slippery slope. Mine for example doesn't show any signs unless goes below 1.7 :banghead:
 
.:. in.active .:. said:
3.1 is not too low on a human meter. But 2.6 is. But look at her go, earning all these reductions! ;)

BTW some cats do well in lower numbers, not to mention they are great at masking, so sometimes their hypo is asymptomatic. Such a slippery slope. Mine for example doesn't show any signs unless goes below 1.7 :banghead:
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Right?! It's too low, but I can't say I'm not pleased about the rate she's earning reductions at. From 4.5U to 2.75U in less than 2 weeks! Can't wait to find out where we'll be 2 weeks from now.

The lowest she's ever tested was 2.1, and no signs during that time either. I'd like to never ever find out what it takes for her to become symptomatic.:bookworm:
 
It's AMPS time and Angel just puked. She was at 14.5 just prior to puking. Should I still shoot if she'll eat soon? I've never been in this situation before so I'm not quite sure what the protocol is.
 
Can you monitor her throughout the cycle and/or would she eat if you left food out for her?
14.5 is a safe number to shoot.
I have been in a similar situation, where he hasn't eaten past AM +7 (was on a brink of unconsciousness) AND puked at PMPS +1 (thank god, at least I knew he was now on the mend, and the meds that caused the O/D was leaving his system). So no food+barf = shot was delayed to PMPS +3 until I could speak to the emergency vet. She advised me to shoot the normal dose.
I left food out for him overnight, he did eat some. They're intuitive eaters, they'd dive in the bowl once they feel the BG is dropping rapidly.
Mine was fine during the PM cycle. Dropped steep in the following AM cycle though due to lack of consiatent food intake - numbers wise only, he was fine pathologically.

If you have similar PS numbers on the same dose, check your data and see how that cycle went. Or if she hasn't eaten still, give her a token perhaps?

I don't know if anyone more experienced will see this in time for your shot (you're already at AM +1 I believe?), but since I'm still awake I thought I'd share my experience, for what its worth.
 
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5 minutes after posting she was already yelling at me for treats again, so I think we'll be okay:D I gave her some and will wait an hour to see if she'll keep it down, and then feed and shoot as planned. She has food freely available.
 
However, I can't stay up with you if you decide to shoot, I'm catching a flight in a few hours.
Therefore I'd say to play it safe and either skip or token her, or if you can stall try and feed and/or wait for another member.

I'm so sorry, I should've started with this :banghead:
 
Lisa and Angel said:
5 minutes after posting she was already yelling at me for treats again, so I think we'll be okay:D I gave her some and will wait an hour to see if she'll keep it down, and then feed and shoot as planned. She has food freely available.
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Oh thank god, I feel less guilty now!
I'm gonna sleep for a couple of hours then. You may even still be awake when I have to get up :confused: I'll keep an eye on the thread ;)
 
.:. in.active .:. said:
However, I can't stay up with you if you decide to shoot, I'm catching a flight in a few hours.
Therefore I'd say to play it safe and either skip or token her, or if you can stall try and feed and/or wait for another member.

I'm so sorry, I should've started with this :banghead:
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.:. in.active .:. said:
Oh thank god, I feel less guilty now!
I'm gonna sleep for a couple of hours then. You may even still be awake when I have to get up :confused: I'll keep an eye on the thread ;)
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No worries, go sleep! I just shot her since it's been an hour and she's acting normal. I'll test her in 2 to 3 hours and then go to bed too if she's not dropped dramatically.
 
I saw this with a huge relief when I woke up, but was in too much of a rush to reply sooner, sorry.
Hope she kept it up throughout the cycle... or down? :smuggrin: The food and the numbers down, but up enough from luminous green.
 
6.3 at AMPS. Decided to shoot a token dose of 0.5U, just to hopefully temper that higher PMPS a bit. Not confident enough yet to shoot a full dose on this number, maybe in the future.
 
Nice little uptick to 8.0 at +3. Heading to bed now, hoping to see a yellow/blue PMPS. Should I make a new thread soon btw, since this one's getting pretty long?
 
Lisa and Angel said:
Should I make a new thread soon btw, since this one's getting pretty long?
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I would yes, as it's already way beyond post #50.
I would also perhaps -don't hate me pliz :confused:- keep threads predominantly for questions, as opposed to reporting on Angel's numbers (I'd insert these comments into the sheet), which are readily available on her spreadsheet in your signature anyway. This would keep your threads shorter and more to the point. (Although I'm not a mod, so not certain on this part of the housekeeping.)
 
How is Angel doing? I see she had a lime yesterday (yikes!) and that you gave her a reduction which is perfect. She did better last night, I see.
 
If you had gotten a +2 test in yesterday’s morning cycle then you would have seen that she was dropping too much or too quickly. Then you could have prevented the lime by intervening with food. Is her appetite good at this point in her recovery? Is she getting a snack at +2? I believe she just grazes, right? Maybe you can make sure she “grazes” around +2?

Per SLGS protocol her reduction should have been .25 units. But given that she was so ill and that her appetite may not be what it was before, I feel good about your reduction. And she had a lovely green last night too.
 
Thanks for checking in @Suzanne & Darcy!

Her numbers are flip flopping a bit. That lime green spooked me bad, especially so early on in the cycle when she usually onsets late. She did eat at +1 and +2, so I can only imagine that her own pancreas decided to join the party and produce some insulin and that's why she dropped so fast and low?

I was going off the previous number (1.75U) when I shot 1.5U, but I think that was too aggressive considering all the factors (illness, antibiotics & weight loss). So to be safe, I reduced down to 1U and wait and see. After a couple cycles I decided to go up to 1.25U anyways, knowing that was the official reducted dose, and because she's been pretty high in numbers and stable in her appetite. I'll try to hold this dose for at least a week, because I know it's not great that we're changing doses so often. She's got 1-2 more days of antibiotics left, so I'm hoping she'll stabilise a bit too once she's off of those.
 
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