decent turned to bad again

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donnahc

donnahc

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I am stumped, I thought we were turning the corner after a decent night, but todays numbers just get worse. He’s been sleeping most of the day too :sad:

Today:
amps 302, shot 2.6 for the 4th cycle
+ 4 300
+ 6.5 380
+9 429

Really bad. No chance of a fur shot, newer bottle of insulin that was never left out, you know all the questions.

So is our only answer the raise in dose is not working and I need to drop down to 1?

Or haven’t I given this enough time yet? He’s been in red and pink for 13 days now. I just think that’s too long and I have to do something else.

My white flag is in the air I think :cry:
 
What is different about the pm cycle? Less food, more food, no activity? If we had those numbers during the day, we'd be real encouraged.........

It looks like 2 flat curves both daytimes. Not really inverse but definitely flat.

Let's see what others think - hold one more cycle or go down.....
 
He sleeps at night and sleeps during the day, he gets treats at night and during the day. I don’t really know what could be that different.
Same food everyday, same amount. I am trying to be mega consistent. He is a puzzle big time.
 
Last night looked good....Today is ugly, especially the 429 at +9.

I thought earlier in the week that it looked like too much insulin and based on this cycle I still do. I know it is hard to decrease after the cycle last night....but, I think it is too much. If you do decrease for a couple of cycles, how much worse can the numbers get? And, if a decrease is the wrong direction-- the cycle ends in 12 hours. If an increase is too much, the high numbers and effects can last much longer than 12 hours. I don't think you have much to lose by decreasing. You are always 12 hours away from "correcting" a decrease.

Just my thoughts...

If you do decrease, check for ketones!
 
The other thing I should mention again is, as I see it we had a few variables that changed...
1. his dental
2. vet put him on a diet, so since a few days before his dental he is on 1/3 less food, so instead of giving him 3/4 can of 3 oz can of food, he gets half can per meal
chicken treats maybe 3 times a day and maybe twice a night, 3 pieces of 1/4” chicken chunks
3. the meter debacle, but that happened right before the dental....
 
The 429 is considerably higher than the preshot of 302-- almost 40 percent. To me that does not appear flat. If we had a 40 percent decrease we would not call it flat. I would see what the +12 or preshot shows you-- if it continues to climb, maybe it was too little??? If it comes back down...definitely inverse to me.
 
I am thinking if we come back down significantly for pmps I’m taking him down to 1 unit. I have to get thru a meeting today, then we’ll test again once before pmps.
I don’t know what else to do, so lowering to 1 unit is what we haven’t tried yet. Although we did go to 1.2 for awhile and that didn’t look great.

I am trying to remember to breathe....
 
I have considered switching twice in the past. We got “regulated” then on pz so I stayed with it. We have had problems for the last month tho. My vet suggested going down to 1.2 but his numbers were so bad we raised again. I was hoping to get thru this but I may have to call the vet again Monday. I am very worried.
 
Best to see the vet and rule out any sickness or tooth issues, and then decide which way to go.
 
The dental and the meter have created a "new" cat in Asher. You will figure it out. You know he responds to Prozinc from your past experience with him---he was as "regulated" as any cat I have seen on Prozinc.

Hang in there...you/we will figure it out.

Good Luck with the meeting!
 
He just had a full dental and lost 3 teeth, the vet did a full blood panel too and everything was fine. No symptoms, no ketones. Just crappy numbers.

He was great for about 7 days after the dental, bad numbers started creeping in, then all hell broke loose.

He was down in blues and greens for the 7 days. Maybe that jump started something that he needed less insulin and I went the wrong way? Dunno.

Down is the only thing left to try. Or maybe he’s back up in the 3 unit range like he used to be. I can’t figure it out at all :sad:
 
If nothing different happens on 1.6 tonight, I'm leaning towards dropping tomorrow, like I posted earlier, to like 1.0 and see what Asher thinks about that. A big enough difference in dose to make an impression. Easier to drop a good bit even if his numbers go up, than to increase a good bit and have him all of a sudden respond.
My 2 cents....
Carl
Click to expand...

That's my story, and I'm sticking to it....
I would try 1.0 for tonight, and tomorrow, test when you can. If lower isn't going to work, you should see that after 3 cycles. And I don't think you necessarily have to climb back up the ladder in tiny increments if the 1.0 obviously doesn't work. It looks like 1.6 isn't working well, so I don't think (if 1.0 is not right), that 1.2 or 1.4 or 1.6 are going to work either.
And like others have pointed out...you know from his past that prozinc can and does work for him. Just not lately for a multitude of reasons. I don't think the insulin is the problem.
Carl
 
Thanks Carl. Doubt we’re gonna have an inverse tonight tho. My clients just left and I just tested him and at 10.5 we have a 449, up 20 points from last test.

(I have to say my client brought his kids, so that might have been stressful, but we hid Asher upstairs so the kids couldn’t terrorize him. Poor Alby got the brunt of that visit :sad: )

So I am gonna count on dropping tonight and we’ll see where that takes us.

Thanks again for the advise. I truly appreciate it. I really think I’m going crazy. (twitch twitch)
 
Dunno if you’re still out there in kittyland Carl, but if we lower tonight and wake up to a 500 or something nasty, do you think we’ll have to wait 3 cycles to know if we have to raise?

edit: +11 is 456, so we’re climbing. ugh.
 
Still here. I'll "unhide" myself. I know I'm here! I forgot other people can't see that.

No, I think if you wake up to a 500, if you have a couple of mid-cycle numbers that show little to no drop, then at most one more cycle that shows the same results would indicate the reduction isn't the way to go. I really try not to base a decision on just one cycle, but if you see it twice with an adjustment that significant, that's "proof" enough to me. We're talking about a 40% reduction, not just 5-10%.

Carl
 
Sounds good, I just wanted to clarify that. So we’re gonna do 1 unit tonight and tomorrow morning. I’ll have mid cycle tests for both cycles, night and day. If numbers look like crap, I’ll raise again tomorrow night.

I know I have no patience but I’m just real nervous he has been so high for 13 days now. Trying the breathe.

Again thanks TONS for helping me thru this nightmare.
 
tons of "you're welcomes" Donna. You know how this place is. We all feel like "your cats" are "our cats" and it's almost like we're right there with you. It's who we've become in life.

Carl
 
I just mentioned to Libby the other day that one of my favorite quotes is from Ram Dass: “We’re all just walking each other home.” I truly believe that.
:YMHUG:
 
Sounds good :-D We can have shirts embroidered ;-)

Yeah Sue, we’re at a loss too, but we just dropped 50 points since the last test I posted, so maybe we will have an inverse curve tonight albeit a small one, at least all this makes a tad more sense if so. I have to go with that for my sanity anyway :shock:
 
That would make a good PZI motto!

I've always considered "You guys crack me up!" to be our un-official motto, but your line is much better!

Carl
 
Well we can have a sub title underneath, they sound pretty funny together:

We’re all just walking each other home.
You guys crack me up!
 
This might sound crazy....it's okay, I have been called worse! But, instead of shooting at your normal +12--why not wait a couple of hours and give the insulin more time to "show itself"--My thinking is, if it is too much insulin, the body is fighting it and as it leaves the body the curve becomes inverse. But, then you shoot again-- even though less...here it comes! Why not wait a couple of hours and see if he continues to come down as the insulin's departure gets further out OR he might climb higher and higher, maybe signifying he needs more....

Okay, call me CRAZY....but, that truly is what I would do. I would let the cycle clear out further.

I tried this with Martha's cat, Risky--- he was 500s all day...for two days...we took a cycle and waited until +16 and he came into the 300s and stayed there for hours--- it made it clear to me he needed less! If he had stayed high, I think I would have thought he needed more.
 
Hi Donna,
I think Asher is flat today because he did see the blue last night
the same thing happened to Shakes today
He had a good night, so he is flat today so I didnt even bother to curve

I am looking at this like we are starting over, which we kinda are!
If they see blue in one cycle, they will be flat the next cycle

If I were you, and I am probably the only one who thinks this,
butI think you should hold for tonight
get some numbers tonight and then if needed up tomorrow


Hang in there! :mrgreen:
 
That is interesting Kim. You know, I was gonna shoot a half hour early tonight, ‘cause what the hell, he’s already in the 400s...but Tom and I discussed it and we said we better wait since he came down 50 points in a half hour. So I’m gonna test again at +12 which is 5:30 east coast time to see if he comes down more.....
 
Denise, I respect your opinion. Shakes is very similar to Asher in many ways it seems. But I think I have to try to lower and just see if this is the way to go. He did nothing but climb today. Believe me, we were back and forth all afternoon about what to do. It makes me crazy. I’ll be back up to somewhere around 2 units in a few cycles if this lowering doesn’t work.
 
Hi Donna,

Obviously I'm super new but that's not going to stop me from giving my 2 cents. I'm not sure why his dose is in the 1 point anything range. For the duration of his SS it seems that in the majority of time he has been in a 2- 3 unit range. Not sure why that is now different. You had a problem of him running low after the dental. I get that! He had a problem and was going hypo levels at night and you had to compensate, which you did but that dental was a month ago, to the date. He displayed these crazy low at night numbers for a duration of 2 weeks and I think that whatever caused that to happen is now clearing itself from his body.

We are now 4 weeks past dental and, to me, I think Asher is not a 1 plus unit cat. I think the dose is too damn low. I think you are not looking at inverse cycles but you are looking at increasing BG numbers because he isn't getting the traction and duration he needs.

I think that whatever...craziness..the dental has created in his body is now past us and you need to start to work him back up. I know the collective wisdom of the board will probably pat me on the head and ask me to go watch some TV while the grown ups are talking but it is an open forum and those are just my thoughts...

My vote goes in for an increase BUT I hope I am totally 100% wrong and sweet Asher does great on 1 unit. After all, we all want to see him, and you, get better.
 
I think my head is spinning. All of your suggestions are all of what has been swirling around in my brain all day.
 
Lisa
I should probably let Donna reply first, but I did want to say something....
Obviously I'm super new but that's not going to stop me from giving my 2 cents
Click to expand...
. Please, NEVER feel like your "newness" makes your 2 cents worth less than mine or anyone else's!
If anyone here ever makes you feel that way, you better tell us about it real quick, and let us adjust our badselve's attitudes.
The very first time I gave somebody my 3 cents, I was new too. But always, always pipe up whenever you want to. Newness has nothing to do with it. It wears off pretty quick too. Have you seen how many people have joined PZI since you did?) You're a veteran already!

Carl
 
Ok, I'll throw my 2 cents in here, because I just HATE to see you chasing your tail. Feel free to ignore it, but here it is.

I would hold the dose at 1.6u. Asher is bouncing from the pretty blue number he saw last night, and the reason his numbers are coming down now is because the bounce is likely clearing. If you drop the dose, all you will accomplish is making is numbers go higher again. When a cat is bouncing, you want to hold the dose until the bounce clears and then assess the dose.

Many cats do go lower at night, and then they bounce during the day, clear and drop again at night IF their pattern is to clear after one cycle. Some cats take 1 cycle to clear, some take 6, or anywhere in between. It does not help the bounce to clear if you drop the dose, a bounce clears in time no matter what you do with the dose.
 
I think my head is spinning. All of your suggestions are all of what has been swirling around in my brain all day.
Click to expand...

Listen to the force, Luke! We are Jedi...
 
Ok, our pmps is 433, so no, we didn’t have an inverse curve. Asher was always a 3 unit kitty. So that is kind of how my brain works.
What could cause him to go so low after the dental? He did great for 7 days, why would he all of a sudden start bouncing?
Because when he was “regulated” he never really was as low as we thought he was because Freesyle Lite meters suck?

I really don’t know what to do. I totally respect EVERYONE’S opinion here. And Lisa, it doesn’t matter that we’ve been here longer than you, you have as much of an idea as I do on this. I appreciate you telling me!

I had my mind made up to lower tonight but my trained brain with a 3 unit kitty keeps yelling at me, "more insulin will fix it”.

I’m gonna go police the eating downstairs, call Tom and discuss it again. Any thoughts yet before I decide what to do?
 
GO with your gut! We all want nothing but lower numbers for Asher and peace for you!
 
The reason he bounced from the blue number is because he has been in higher numbers for 2 weeks....his body is used to those higher numbers, his body thinks the high numbers are "normal" so when he goes into much lower numbers, his liver sees it as "too low" and reacts by dumping glycogen and counter regulatory hormones to boost his BG...that's why his numbers climbed steadily from the blue through the AM cycle.

If you look back to 2 weeks ago, you will see the same pattern when he had blue/green cycles at night, then higher numbers the following AM cycle, then blue/green at night, etc. When you held the dose, he got right back down to blue/green again....look back and see....
 
Laurie and Lisa,
I am not sure if you were around during what Donna mentioned.....the "freestyle sucks" phase. Both Donna (and Asher) and Denise (and Shakes) found out weeks ago that the freestyle meters they had been using forever had given them totally bogus numbers, for nobody knows how long. So when you look back at Asher's SS, none of the old data is worth a darn. When Asher was getting those big doses, and his numbers look good, the numbers are "not right". They were all "low" by about 100 points. This would date back to the 2nd week of January. Then the dental further complicated things when the previously "normal doses" started giving long cycles and hypo number cycles, so the dose was dropped a good bit. Since then, it's been pretty much chaos.
Carl
 
carlinsc said:
Laurie and Lisa,
I am not sure if you were around during what Donna mentioned.....the "freestyle sucks" phase. Both Donna (and Asher) and Denise (and Shakes) found out weeks ago that the freestyle meters they had been using forever had given them totally bogus numbers, for nobody knows how long. So when you look back at Asher's SS, none of the old data is worth a darn. When Asher was getting those big doses, and his numbers look good, the numbers are "not right". They were all "low" by about 100 points. This would date back to the 2nd week of January. Then the dental further complicated things when the previously "normal doses" started giving long cycles and hypo number cycles, so the dose was dropped a good bit. Since then, it's been pretty much chaos.
Carl
Click to expand...

Yes. I was here during that mess. However, I was looking at the number levels, overall flow, whatever you want to call it ...and not the actual numbers. I am aware of the FSL reading lower than any other meter on the planet.
 
Yes, I have no idea when Freestyle changed their strips last year, so those numbers could be off 30-100 points, we have no way of knowing.
The other variable is that our vet put Asher on a diet, so since Jan 20th he has been on 1/3 less canned food. So he eats half of a 3 oz can twice a day, not 3/4 can.

So less food may mean less insulin now, but before all this chaos he still was on 2-3 units of insulin to hold numbers that were probably higher than our chart shows.

Do you really think 3 bad teeth and a diet could change him from a 3 unit cat to a 1 unit cat?

I just spoke to Tom on the phone again and his vibe is we need to raise not lower. We do realize insulin is not a medicine, that it works differently.

My head is still spinning, but I am leaning towards holding tonight at 1.6 yet...ugh I know, and hour ago I was gonna lower.
 
Yup, I saw that...Jan 13th was the meter debacle. I'm talking about February.

IMHO, you were doing great in the beginning of February, nice blues and greens. Then you got a couple of nights that he hit 40s and you dropped the dose way down, from 2.0u to 1.4u and that's when things went south. You jumped around on dose, and all that did was give you wonky numbers (that was my experience with PZ too, I never did sliding scale because I found that consistent dosing worked better for us) that made it impossible to see what a good dose was. I think you will find out more by sticking with the 1.6u for a cycle or a few cycles, then if his numbers are still not getting down far enough, go up a bit more. If he goes too low (below 50), then drop the dose by a little. You just dropped the dose too much IMHO.

ETA: Donna, you have to do what you feel is right. I'm just sharing my analysis of what I see in his SS in the hopes that it will help you figure out how to get Asher back into good numbers. :-D It won't hurt my feelings at all if you choose to do something different than what I suggest!
 
Ok I gotta shoot. Please please don’t anyone be offended that says we should drop, but I’m gonna hold 1.6 tonight. Kim is right, it’s 12 hours.

Tom my partner is away tonight and trying to talk on a bad connection is making me crazy too. In the morning he will be here and we can reassess.

Laurie, I agree with what you are saying about dropping the dose in Feb. I think messing around with the dose, and feeding him to bring him up from the 40s (more food and higher carb at that) screwed up our consistency. We too always found the more consistent we are with dose and food is better for us.

I thank you ALL so much for taking the time to look at our ss and hash this out. I do apologize for any drama and my back and forth. I think I need to go shoot some insulin and then make a drink for me. drinking09

Hugs and huge thanks to you all. You’ll be the first to know how it all works out nailbite_smile :shock:
 
Sounds like a good plan, Donna. You know us, we'll be here to celebrate or commiserate - whatever is needed.

And the whole thread is wonderful. It will help us the next time, with some other kitty.
 
carlinsc said:
Both Donna (and Asher) and Denise (and Shakes) found out weeks ago that the freestyle meters they had been using forever had given them totally bogus numbers, for nobody knows how long. So when you look back at Asher's SS, none of the old data is worth a darn.
Click to expand...

I don't think it negates the data; I just think it changes how we should interpret it.
 
Ha! My craziness can be used as a teaching tool :shock: Twitch, twitch.

I love it. I am all for that really. If my wringing hands can help someone else dodge that stress, I think it’s great.

Lisa, I do agree with what you said.
I don't think it negates the data; I just think it changes how we should interpret it.
Click to expand...
I think we can look at trends, what kept him in similar numbers, etc.
 
Laurie
I wasn't here when you were beiore, but I am very happy to see that "old time" people have come back lately because experience is the top commodity on the board. I would like your opinion or thoughts about "inverse curves", because I'm sort of on the fence as to what they mean.

1 - how drastic does the upside down smile have to look to be considered "inverse" rather than just flat and within meter variance.
2 - how many times do you need to see one before it makes an impression? How often does it need to show in the numbers before you make a decision relating to dose?
3 - do they always indicate a dose that is too high?
4 - is it something like a "bounce" where you just have to live with it until it clears?

Thanks for any input you can give. For me this place is "all about the learning" so anytime I can file something in the space between my ears, I try to do that.

Thanks!
Carl
 
Thanks Carl, I have all these questions too, plus, I wasn’t aware a bounce could last all day, I thought it was just a ps number and it went away eventually...but I never really had a kitty that bounced before....
 
carlinsc said:
Laurie
I wasn't here when you were beiore, but I am very happy to see that "old time" people have come back lately because experience is the top commodity on the board. I would like your opinion or thoughts about "inverse curves", because I'm sort of on the fence as to what they mean.

1 - how drastic does the upside down smile have to look to be considered "inverse" rather than just flat and within meter variance.
2 - how many times do you need to see one before it makes an impression? How often does it need to show in the numbers before you make a decision relating to dose?
3 - do they always indicate a dose that is too high?
4 - is it something like a "bounce" where you just have to live with it until it clears?

Thanks for any input you can give. For me this place is "all about the learning" so anytime I can file something in the space between my ears, I try to do that.

Thanks!
Carl
Click to expand...

Inverse curves can mean too much insulin, but in my experience, most "inverse curves" that people see are not related to too much insulin...they often are just a bounce that makes the curve inverse due to the timing. Likewise with flat curves, they often are indicative of a bounce. I don't look at how drastic the inverse curve is, I look at the patterns on the SS, it's a picture and one cycle is only a piece of the picture. I have rarely seen cats with inverse curves that are related to too much insulin....not that it can't happen, but it isn't common in my experience here on FDMB.

Bounces can last anywhere from a few hours to a few days...it depends on the cat, and even the same cat can vary. On the Lantus TR forum, we usually tell people to allow up to 72 hours for a bounce to clear. When the bounce clears, the numbers will come back down, and that can happen at any point during the cycle. Sometimes you will see a "late nadir" that is related to the bounce clearing.

If an inverse curve is a bounce, it does not tell you anything about dose. A bounce is simply the liver's reaction to what it perceives as the cat's BG being too low, OR the BG dropping too fast. The more time the cat spends in the lower numbers, the more it's body gets used to the lower numbers and it becomes the new "normal". The one thing you don't want to do when a cat bounces is raise the dose before that bounce clears. Your cat may end up over dose when the bounce clears, and the numbers could drop low. Wait for the bounce to clear, then see where the nadir ends up before deciding on an increase/decrease.

Let me look for some more info on inverse curves...
 
Ok, I knew I just saw Jill post something about inverted curves...she has many more years of experience than I do so I always pay attention to what she has to say. ;-)

one more thing i'd like to cover because i saw it mentioned a few times in your pzi threads is inverse curves.

inverted curves can be signs of:
--- too much insulin
--- not enough insulin
--- a late nadir

when a kitty is taken up the dosing scale in the systematic and methodical manner we use in LL we do not give much thought to an inverse curve until kitty is very, very close to going OTJ.

late nadir kitties will also have inverted curves. inverted curves do not always mean the dose is too high.
Click to expand...

The only kitties that I can think of that had inverted curves due to too much insulin were kitties who were very close to OTJ. Keep in mind that the majority of my experience has been in Lantus TR.

I do need to fix one thing I said, because it was not clear and could be misinterpreted....

The one thing you don't want to do when a cat bounces is raise the dose before that bounce clears. Your cat may end up over dose when the bounce clears, and the numbers could drop low. Wait for the bounce to clear, then see where the nadir ends up before deciding on an increase/decrease.
Click to expand...
If the cat has gone too low before bouncing, then the dose should be reduced based on that, regardless of the bounce. I always used 50 as my cutoff when Mr Tinkles was on ProZinc. If he dropped below 50, I reduced his dose immediately.
 
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