HELP!: 1/29 Terra +12 59 +13 87 +14 117 +15 161

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KarenAmelia

Member Since 2012
Please read update at bottom of thread. Terra's just had a dramatic change in the magnitude of her BG numbers. I think I need some revised advice from Sienne and Beth and any others who care to comment.



Terra continues up and down, pretty dramatically. I'm concerned about the continued ups and downs, as if she's not responding to the insulin. Today she won't eat, sits hunched over, threw up foamy liquid. She's sleeping now. She acted like she was hungry for a while earlier but just couldn't stomach the food. She has been alternating - a day of feeling and acting good , a day of pretty lousy. THis seems to be the only constant, along with negative ketones.

There were some earlier posts concerning side issues to look for, which I will reread when I have a moment.

I am going to talk with the vet tomorrow and ask him whether there might be another underlying problem. I want to ask the experienced folks on this board to comment on Terra's spreadsheet: what do you see happening? It would be helpful if I could be better informed when I talk with the vet, since he isn't up to date on FD.
 
Re: 1/29 Terra AMPS 406 +3 237 NEED ADVICE?????????????

Type 2 is characterized by two problems. The first, as in Type 1, is a diminished ability of the pancreas to secrete insulin. The second issue is one of insulin resistance. In other words, the receptors on the cell wall that would normally open the door to the cell to let the glucose in when insulin 'knocks', stop 'listening' to the insulin. The cells 'resist' the signal that the circulating insulin is sending and the glucose is not transferred to the inside of the cell, resulting in an elevated blood glucose (hyperglycemia) and cellular 'starvation'. The elevated blood glucose, in turn, sends a signal to the pancreas telling it to secrete more insulin. The elevated insulin may somewhat override the insulin resistance resulting in more glucose entering the cells, but eventually the pancreas can become exhausted or 'burned out'.

http://www.catinfo.org/?link=felinediabetes
Click to expand...

To me this appears to be the issue at this point. Insulin Resistance. You are not yet high enough to consider an "acrocat," but that may be creeping into this picture.

I would wait for a few other opinions as the way to deal with it is to increase your insulin doses fairly aggressively.

Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days.

However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU.

Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose)

http://www.tillydiabetes.net/en_6_protocol2.htm
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Re: 1/29 Terra AMPS 406 +3 237 NEED ADVICE?????????????

IMHO, Terra is bouncing. Her numbers drop -- like you've seen today. This morning, she's dropped almost 200 points. That's substantial. A bounce is triggered either by a cat going into lower numbers than she's used to or a fast descent. As a result, the liver reacts as though there's a hypoglycemic event. This is a normal reaction on the part of the liver. The result is that a stored form of glucose along with counterregulatory hormones are released. It can take up to 72 hours for the bounce to clear. I think if you venture into other people's condos where you see these same patterns or look at a lot of spreadsheets, you'll get a better sense that Terra is not the only cat who does this. Once Terra gets to a dose that is better meeting her insulin needs, numbers will start to come down and the bouncing is likely to be less of an issue.

Many cats do not feel great either when they are in BG ranges they are not used to or if their numbers are bouncing up and down. As Terra becomes more accustomed to lower numbers, she'll start feeling better when she's in those lower ranges.

If you are not feeding between nadir and pre-shot, it may be that Terra develops a bit of an acid stomach. Pepsid, 30 min. before a meal may help to get her stomach settled. I would suggest you ask the vet to run an fPLI -- this is a test that is specific for pancreatitis. I know you've mentioned that she has trouble jumping. Is there any pain or discomfort involved - arthritis or neuropathy? Pain can raise BG levels. Has she ever had a dental? Gingivitis or other dental problems (e.g. resorptive lesions) can cause inflammation and/or pain and raise BG. Are there any FIV-related issues going on?
 
Re: 1/29 Terra AMPS 406 +3 237 NEED ADVICE?????????????

Okay, so far I hear that she may be insulin resistant and would need agressive increases of dose.

On the other hand, she could be bouncing - in which case, do ..what? Sienne, do you recommend holding the dose steady for a bounce?

Is there any health danger from Terra, as a glucose -toxic and high glucose-tolerant cat, having her BG drop into numbers that are for her low but in fact are higher than normal? Is it damaging to her body ? I 'm a bit confused: if her liver is pouring glucose into the bloodstream, that is being robbed from her tissue and I should be seeing muscle loss or ketones, shouldn't I?

I will ask vet to check on pancreatitis and possible dental problems (although last week Terra was crunching on dry food so I sort of started to rule out dental pain.)

I have been feeding pretty frequently - every hour or every other hour, if she seems to want to eat. I've been limiting this feeding from about +7 on to the end of the cycle, unless she's demanding food pretty assertively. Terra's eating seems to alternate days: for one or two days she eats well, the next, she refuses to eat. She stays in bed and sleeps for a day and then seems to bounce back the next day. So far, negative ketones.

What's the worst that could happen from aggressively raising dose? Is it hypo? So if I watch her numbers fairly closely , would it be adviseable to go ahead and try the aggressive increase that Beth talks about? She isn't getting anywhere close to hypoing yet. Since there's such uncertainty as to what's happening, it could be a way to move ahead with one hypothesis and, if it doesn't work, then rule that out. Alternately, since she's so accustomed to glucose toxicity by now, I could keep going very slowly and see if eventually the apparent resistance breaks through.
 
Re: 1/29 Terra AMPS 406 +3 237 NEED ADVICE?????????????

I generally don't start thinking about a high dose condition, like insulin resistance (this is really insulin autoantibodies or IAA) until we see a cat getting closer to 6.0u of insulin. It may be a worth considering but I don't think you're quite there yet. You may want to ask your vet to send out a blood sample to Michigan State since you're planning on talking to your vet anyway. (We usually suggest getting tests for acromegaly and IAA all at once since the cost isn't appreciably more and both tests are only run at MSU.) But, like I said, there are a number of cats who hit a breakthrough dose at over 5.0u.

With a bounce, you want to wait for it to clear before raising the dose. Remember, Lantus dosing is based on nadir, not pre-shot. You don't want to have a knee jerk reaction when you see a higher than you'd like pre-shot number. Also, once a bounce clears, you could be in better numbers and if you are raising the dose too aggressively, you could put your cat over what would be a good dose.

When the liver reacts, it's not pulling glucose from other places so that's nothing to worry about. (Also, ketones aren't part of this equation.) The liver produces and stores glucose in a form called glycogen. It is a major component of the liver cells. In combination with a pancreatic hormone, glucagon, when numbers drop, both of these forms of glucose respond and BG numbers rise. This is the body's built in "emergency" system so in a way, it's a very good thing to see.

I wasn't clear about how you were feeding. Are you feeding after nadir? If so, I'd encourage you to not do so -- at least not now. If you're giving food past the point where Lantus is most active, there's just not that much insulin available to offset the effect of the food. Rather than helping to stoke metabolism, you may be overwhelming both the Lantus you've injected and and insulin Terra's pancreas may be producing and numbers keep going up. I'd suggest letting Terra have all of her food before nadir. If she wants to graze for a while beyond that, especially if she hasn't eaten well, that may be OK but it's probably best to not let her eat past nadir. Also, be sure that you pick up all food by +10. Letting her eat 2 hours before shot time may cause higher pre-shot numbers.

Karen said:
What's the worst that could happen from aggressively raising dose? Is it hypo? So if I watch her numbers fairly closely , would it be adviseable to go ahead and try the aggressive increase that Beth talks about? She isn't getting anywhere close to hypoing yet. Since there's such uncertainty as to what's happening, it could be a way to move ahead with one hypothesis and, if it doesn't work, then rule that out. Alternately, since she's so accustomed to glucose toxicity by now, I could keep going very slowly and see if eventually the apparent resistance breaks through.
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It depends on what you mean by "aggressively raising dose." I don't believe Beth is suggesting increasing the dose if Terra is bouncing. I think she's pointing out that you can raise the dose after 2 - 3 days IF it's not during a bounce. And yes, you would need to monitor especially closely if you raise the dose after 2 days. Remember, a new Lantus dose needs time to settle.

Let me step back for a moment. The whole point of a tight regulation protocol is to aggressively raise the dose. If you compare the information that Beth provided with the Start Low Go Slow (SLGS) approach, you'll have a better sense of the difference. However, with the TR Protocol, the point is to get numbers down as quickly as possible but also as safely as possible. Increasing doses when a cat is bouncing is not safe. So, there's that fine line of figuring out when to time the dose increase and sometimes, especially when you're still new at managing FD, it can be hard to know when your cat is bouncing.
 
Re: 1/29 Terra AMPS 406 +3 237 NEED ADVICE?????????????

Hi, Karen and Terra!

I think Sienne has got you covered here. :-D

I did want to let the forum folks know that the other day I sent Karen a pm advising her to follow my lead on ONE strategy...

" Don't be afraid to ask questions. If something isn't clear, or does not make sense to you- ask, ask again, and continue to ask
until it becomes clear. The folks here had infinite patience with me...and are truly gifted and kind in helping walk us through this."

so if her posts start to sound like mine did when you were teaching us the dance...
you'll understand why! :-D :-D :-D

celi & binks
 
Re: 1/29 Terra AMPS 406 +3 237 NEED ADVICE?????????????

Sienne and Gabby said:
I generally don't start thinking about a high dose condition, like insulin resistance (this is really insulin autoantibodies or IAA) until we see a cat getting closer to 6.0u of insulin. It may be a worth considering but I don't think you're quite there yet. You may want to ask your vet to send out a blood sample to Michigan State since you're planning on talking to your vet anyway. (We usually suggest getting tests for acromegaly and IAA all at once since the cost isn't appreciably more and both tests are only run at MSU.) But, like I said, there are a number of cats who hit a breakthrough dose at over 5.0u.

With a bounce, you want to wait for it to clear before raising the dose. Remember, Lantus dosing is based on nadir, not pre-shot. You don't want to have a knee jerk reaction when you see a higher than you'd like pre-shot number. Also, once a bounce clears, you could be in better numbers and if you are raising the dose too aggressively, you could put your cat over what would be a good dose.

When the liver reacts, it's not pulling glucose from other places so that's nothing to worry about. (Also, ketones aren't part of this equation.) The liver produces and stores glucose in a form called glycogen. It is a major component of the liver cells. In combination with a pancreatic hormone, glucagon, when numbers drop, both of these forms of glucose respond and BG numbers rise. This is the body's built in "emergency" system so in a way, it's a very good thing to see.

I wasn't clear about how you were feeding. Are you feeding after nadir? If so, I'd encourage you to not do so -- at least not now. If you're giving food past the point where Lantus is most active, there's just not that much insulin available to offset the effect of the food. Rather than helping to stoke metabolism, you may be overwhelming both the Lantus you've injected and and insulin Terra's pancreas may be producing and numbers keep going up. I'd suggest letting Terra have all of her food before nadir. If she wants to graze for a while beyond that, especially if she hasn't eaten well, that may be OK but it's probably best to not let her eat past nadir. Also, be sure that you pick up all food by +10. Letting her eat 2 hours before shot time may cause higher pre-shot numbers.

Karen said:
What's the worst that could happen from aggressively raising dose? Is it hypo? So if I watch her numbers fairly closely , would it be adviseable to go ahead and try the aggressive increase that Beth talks about? She isn't getting anywhere close to hypoing yet. Since there's such uncertainty as to what's happening, it could be a way to move ahead with one hypothesis and, if it doesn't work, then rule that out. Alternately, since she's so accustomed to glucose toxicity by now, I could keep going very slowly and see if eventually the apparent resistance breaks through.
Click to expand...
It depends on what you mean by "aggressively raising dose." I don't believe Beth is suggesting increasing the dose if Terra is bouncing. I think she's pointing out that you can raise the dose after 2 - 3 days IF it's not during a bounce. And yes, you would need to monitor especially closely if you raise the dose after 2 days. Remember, a new Lantus dose needs time to settle.

Let me step back for a moment. The whole point of a tight regulation protocol is to aggressively raise the dose. If you compare the information that Beth provided with the Start Low Go Slow (SLGS) approach, you'll have a better sense of the difference. However, with the TR Protocol, the point is to get numbers down as quickly as possible but also as safely as possible. Increasing doses when a cat is bouncing is not safe. So, there's that fine line of figuring out when to time the dose increase and sometimes, especially when you're still new at managing FD, it can be hard to know when your cat is bouncing.
Click to expand...

:thumbup Sienne has got it. I am sorry if it wasn't clear in my post as I did state you were not at the acrocat stage. Thanks for the clarification Sienne.
 
Re: 1/29 Terra AMPS 406 +3 237 +6 46 +9 48 +10 60

??????????? Advice REALLY needed now! Dramatic shift in the numbers:

Terra has not gone anywhere near these numbers for past few weeks, even with refusing to eat on several occasions.

Literally minutes before I was out the door for a busy afternoon, I tested and found she was 46. I knew I couldn't cancel my afternoon plans unless it was going to be a life or death situation for her , and so I waited and tested in 15 min. to see if she was plummeting. Because of my plans and her not eating, I rubbed honey on gums once, prayed for the best, and left. Came back to check in at +9; she was holding steady. At +10 she's on the increase. Her welfare appears good.

This morning she acted in discomfort. I saw that she'd thrown up liquid in several places. Gave a quarter tab Pepcid crushed and diluted with a bit of water. In the afternoon, at the time of the low reading, her condition was much improved. She was wanting to go outside, walking around, not appearing in discomfort but was thirsty. Not acting hungry, but I got her to eat a few bits of chopped chicken.

Will talk to vet tomorrow; do not think this is an emergency. But would like guidance. Should I not inject at PM unless BG is above 150? Should I hold dose or decrease?
 
Re: NOTE CHANGES: 1/29 Terra AMPS 406 +3 237 +6 46 +9 48 +10

bumping your post for more experienced eyes, Karen...

I have to say...a decrease seems definitely earned here!
 
Re: NOTE CHANGES: 1/29 Terra AMPS 406 +3 237 +6 46 +9 48 +10

Any time kitty's BG goes to 50 or below, they earn a decrease. How much of a decrease, I would have to defer to more experienced folk here.

You will likely see another bounce from this and her numbers will be going up steadily by PMPS time.

Keep an eye on her and do another BG when you can and post the reading in the thread. Honey and/or food will wear off after a bit.

Congratulations on the dose decrease, she's earned it :mrgreen:
 
Re: NOTE CHANGES: 1/29 Terra AMPS 406 +3 237 +6 46 +9 48 +10

when was the last time Terra ate and/or had syrup? And what + hour is it now? You want to keep testing because sometimes the numbers drop after the food/syrup wears off.
 
Re: HELP!: 1/29 Terra AMPS 406 +3 237 +6 46 +9 48 +10 60 PMP

bump

numbers not really increasing. her welfare is good: she acts okay, not hurting, moving around , decent energy, aware of and responsive to surroundings, but still not eating much. just after PMPS test, I fed a smorgasbord of two diff canned foods, and some chopped up chicken breast and liver. She only ate the chickens, no canned, even with sprinkled dry food on top. Do I need to make her eat? I will need advice over the next few hours: when and how much to dose? If I don't hear from folks I may have to skip shot, but it would be a shame to waste the apparent progress.
 
Re: HELP!: 1/29 Terra AMPS 406 +3 237 +6 46 +9 48 +10 60 PMP

Karen:

Is the 59 the number you got and shot or is it her +12 and you haven't shot? If you haven't shot...good. Since you haven't had low numbers before, it's best to stall about 15-20 minutes and see if she is coming up.

Can you also pls let us know the answer to Libby's questions? Thank you! :-D
 
Re: HELP!: 1/29 Terra AMPS 406 +3 237 +6 46 +9 48 +10 60 PMP

OK, if her BG is the reading you got 12 hours from when you last gave her insulin and you haven't given her another injection, then in your subject line you want to put "PMBG 59" or +12/59.

PMPS stands for PM pre shot, which assumes you have given her insulin and scares us all half to Jesus seeing that @-)

I wouldn't feel comfortable giving Insulin tonight at this point since you're still trying to even her out.

This is also why we keep a can or two of high carb and medium carb food around. It's tasty and kitty will eat it eagerly.
 
Re: HELP!: 1/29 Terra AMPS 406 +3 237 +6 46 +9 48 +10 60 PMP

Let's not throw the baby out with the bath water just yet.....if you haven't shot, then don't feed and let's see what she does. If she comes booming up from those low numbers, then you want to catch her on the rise and shoot to try and get a little overlap. Ok?
 
Re: HELP!: 1/29 Terra AMPS 406 +3 237 +6 46 +9 48 +10 60 PMP

Marjorie, I think Karen may have already fed her based on this in her previous post:

just after PMPS test, I fed a smorgasbord of two diff canned foods, and some chopped up chicken breast and liver. She only ate the chickens, no canned, even with sprinkled dry food on top.
Click to expand...

I'm interested to follow along and see how feeding influences what direction this goes with giving insulin.
 
Re: HELP!: 1/29 Terra AMPS 406 +3 237 +6 46 +9 48 +10 60 PMP

Thanks, Cathy...I cross posted with her when she said that....glad you pointed it out.

Karen: please read "Dealing with Low Preshots" in my signature block. When you get a low PS, we ask that you do not feed, post, and ask for assistance. I know you had some troubles the other day but there are alot of us on today and it would have been the perfect time to walk you through it. Since you have fed her, we now have to wait to give her insulin because the BG will be food-influenced. This is why we say do not feed from +10-+12 unless kitty is realllly low (like in the 40s).

Can you post a +13 and let's just see how much of a food spike she got? Also..what is the %calories from carbs of the food you gave her and how much did you feed?
 
Re: HELP!: 1/29 Terra AMPS 406 +3 237 +6 46 +9 48 +10 60 PMP

Thanks for the replies, all.
Okay, I will use PMBG from now on. I did not give insulin, but was calling the +12 the PMPS.

I did feed after the +12, because I figured I wouldn't likely be giving insulin this evening b/c of low numbers, and she's used to eating at that time. However, she still didn't eat much: a teaspon or two of chopped up chicken breast and liver , and maybe a teaspoon of EVO 95% Chicken & Turkey. I can do number crunching if you want the carb % - don't have it now. I'll get a +13 test. What's the best way to update this thread?
 
Re: HELP!: 1/29 Terra AMPS 406 +3 237 +6 46 +9 48 +10 60 PMP

Sorry, didn't answer Libby's question. I gave one gum-rub of honey at +6. Then I tried to get her to eat, but all day she has only picked at bits of chicken. That is true even now - minimal food intake. Maybe a Tablespoon of chopped meat. Less than that of canned food.
 
Re: HELP!: 1/29 Terra AMPS 406 +3 237 +6 46 +9 48 +10 60 PMP

ok....open the FIRST post of the day, click on "edit" and then edit your subject line so it reads:
1/29 Terra +12 59 stalling...then click "submit".

When you get her +13, just post it. You don't need to get the %carbs....I know what those are...thank you.

Are you going to be there to monitor her all night and do you have plenty of test strips and HC food/gravy/karo there?

If you haven't fed her since +12, please don't and let's just see where she is, ok?

ETA: Karen...have you been able to pull all the dry food? When was the last time she had it? Also...how long can you stall and still be able to shoot 12 hours from when you shoot tonight? I'm only thinking that if she is fairly high by +14 and you can stall that long and be ok the next few days while you get her on schedule, you might consider shooting. Let's discuss the above first.
 
Re: HELP!: 1/29 Terra +12 59 +13 87 stalling

+13 is 87. She ate a tiny bit an hour ago , that's it. No dry food for the past few days.

Yes, I do have the time available to be able to shoot at any hour tonight and then to return her over the next several days to the "normal" time. I can also be up to monitor, but she's on the upswing now. Any next shot would carry as a concern the fact that she's not eating. And whatever little she ate today was well below normal, so it seems the increase in BG caused by eating would be pretty nominal.

I'll stay close to the computer. Should I be watching for 150?
 
Re: HELP!: 1/29 Terra +12 59 +13 87 stalling

Thanks for the info Karen. Here are my concerns:

1. you haven't shot low before
2. I think this might be a food spike...at least partially
3. she's iffy on the eating.

If you can stall, I'd be more comfortable if we get a +13.5 and if needed a +14. If she's up, that's great because she should be out of the food spike by about then but I still have concerns about whether you can get her to eat. While we do not usually stall AND shoot a reduced dose, with her not eating well, it would still allow you to get some insulin in her without worrying about her numbers tanking too much....altho you still have to monitor closely tonight due to that cumulative nature of Lantus.

Let me know whether you want to continue to stall or skip and feed. I've got to test Gracie but be back in 5.
 
Re: HELP!: 1/29 Terra +12 59 +13 87 stalling

I can do whatever is best. Terra is up and clamoring for food now. But I'm not feeding...yet. If I skip tonight's shot, will that cause us to lose ground? I will take whatever your suggestion is. I am okay with skipping. But it's hard to predict if she's going to eat or not. Could I wait and see if she comes up to a safe number (150 ? whatever you suggest as safe threshold) and then if she will eat well after that, which could determine if she's going to be safe with a late shot.
 
Re: HELP!: 1/29 Terra +12 59 +13 87 stalling

Certainly....check her at +13.5 and +14 and see where she is. Then we can decide but she has to come up alot...absolutely no lower than 150 but even if she is there...please do not shoot without checking in so we can get an update on how she is doing.
 
Re: HELP!: 1/29 Terra +12 59 +13 87 stalling

+14 is 117. missed a +13.5 no feeding. she's sitting at the food station, waiting...
 
Re: HELP!: 1/29 Terra +12 59 +13 87 +14 117 stalling

I'd skip. She's not up high enough and she hasn't been eating well enough to shoot this low. Yes....she will most likely bounce and maybe relatively high but safety first. She'll be ok and this should not put her far behind...we've all had to skip shots or we've all given a fur shot and they get back on course pretty quick.

She's earned a dosecrease to 2.75u. I've got to give my civvie squids...was just waiting on your +14. I'll be back in about 40 minutes (have to do Gracie, too) to pass on some other important thoughts.

Go ahead and feed her :-D :-D
 
Re: HELP!: 1/29 Terra +12 59 +13 87 +14 117 stalling

I know ECID- every cat is different...
but Binks never missed a beat when we had to skip a shot...

nice work here, guys!

celi
 
Re: HELP!: 1/29 Terra +12 59 +13 87 +14 117 stalling

Thanks Celi. Maybe that's where the shed comes into play. I was wondering, before i saw your post, if it would be good to give a token dose of a fraction of what she's now getting, but that doesn't follow any protocol.
 
Re: HELP!: 1/29 Terra +12 59 +13 87 +14 117 stalling

KarenAmelia said:
I was wondering, before i saw your post, if it would be good to give a token dose of a fraction of what she's now getting, but that doesn't follow any protocol.
Click to expand...

actually, I hate to add to the confusion of all the info you are trying to assimilate...
but we do sometimes give a "token dose", or what we call a "BCS" ( Big Chicken Sh*t) dose...
I'll go see what sticky that's in and try to clarify it :-D
 
Re: HELP!: 1/29 Terra +12 59 +13 87 +14 117 stalling

okay, i'll just wing it here on the clarification...

BCS dose is generally used when Kitty is too low, and you can't be available to monitor.
In Terra's case, i think skipping was advised for 2 reasons...
she' not eating well for you tonight, and as you are kind of new to this,
there's not enough data to reliably predict how she would respond if you did shoot.

(Wiser ones than I... if I have that wrong, PLEASE correct me :-D )

celi
 
Re: HELP!: 1/29 Terra +12 59 +13 87 +14 117 stalling

Good thing : she's back to eating. Just had two good noshes. And she played , with me and the bug on a string, tonight, like old times. Wow, she's feeling better! I hope this is the beginning of a new phase for Terra (after the bounce.)
 
Re: HELP!: 1/29 Terra +12 59 +13 87 +14 117 stalling

absolutely heartwarming when they start to show they're feeling better! :-D
 
THanks Celi for clearing things up while I was taking care of cats. Sorry it took me longer than I expected.

I have to say the +15 is not all that unpredictable. Hopefully the shed will help her somewhat with the numbers not getting too terribly high but just don't be shocked.

Just a few things I wanted to add to sort of tidy up the day :-D We want this to be a learning experience.

Literally minutes before I was out the door for a busy afternoon, I tested and found she was 46. I knew I couldn't cancel my afternoon plans unless it was going to be a life or death situation for her , and so I waited and tested in 15 min. to see if she was plummeting. Because of my plans and her not eating, I rubbed honey on gums once, prayed for the best, and left. Came back to check in at +9; she was holding steady.
Click to expand...

We all have lives....and we have to balance those lives with FD. There's no doubt about that. But just because Terra was at 45 when you left and 48 when you returned three hours later does not mean she was safe. This actually scared me to death. Why? Because you don't have enough data on her at these low numbers to know what she'll do. If she isn't eating, she could have easily dropped lower at a time when her insulin was at its peak. The 40s are safe when monitored. But she could have gone much lower while you were gone. I am glad that she is ok.....

FD is unpredictable and while chances of fatal hypos are less on lantus....they have sadly happened to a couple beans who have come home and found their cats at numbers unreadable (lo) on the meters. We don't know at what numbers brain cell death occurs due to glucose starvation.

The last eight cycles, you've finally had some consistency and done some good testing and we are very happy about that. But for a kitty to go from 406 to 46 in six hours...huge drop. This is why we wanted you to be careful about increasing the dose the other day. Here is a summary of her dosing:

Increased from 1u to 1.5u after 4 cycles with essentially no data
Increased from 1.5u to 2u with even less data – only 3 tests on one day, all in 300s, was this a bounce cycle or not?
Increased from 2u to 2.5u after 6 cycles with two curves in a row – in 400s and 500s, sure does look like a bounce cycle but bouncing from what? No data the previous 4 cycles.
Increased from 2.5u to 3u after 9 cycles with more testing and at least one cycle went to lower blue. Was probably still bouncing when dose increased, and increase should have been no more than 0.25u because of the blue and yellow on the SS.
And now hitting 40s on 3u.

We are ALWAYS happy to help you and to help Terra and answer your questions. One thing that would help us is to know which protocol you are following with her...the TR or the SLGS? You are welcome in LL for either one but we just need to make a note of it so our suggestions are for the appropriate protocol.

Please let me know if you have any questions. I hope you understand that my comments are to help you see what set her up for this drop today. We all make mistakes in this dance but we need to learn from them in order to keep our kitties safe.
 
Thanks Marje for your last post. I know this is meant for education for others as well as for me.

I did not leave home this afternoon without getting a second test. I knew it would be foolish to leave if she was dropping, but the second test, 15 min. later, showed that she was holding steady. From reading a number of condos here I notice that people test for trends as well as absolute numbers. If her second test had been lower, I would've stayed home with her.

As for what method, it's clearly not SLGS. That method has no changes for a week at least, with no testing intermediate to getting a curve at the end of each week. At least that's what I remember reading of it.

I had some difficulty with her diet initially, transitioning her off dry food. It's been one day at a time with her eating habits, never predictable. So according to the rules, I should not have been trying for TR. I think that as a beginner, those cycles seem awfully long - I was freaking out initially seeing numbers in the 500s and even above, and time sort of expands for the newbie, so waiting 72 hours seems like FOREVER. Also I wasn't asking for advice from this board right away either - it took a bit of time to learn the ropes and so I posted on the Feline Health board at first. So...there was some period of time that elapsed before I learned enough to try the TR, but it didn't seem appropriate to me to start over at the very beginning. So... that's to say that it has taken a while to sort this all out. I think a bit more orientation at the outset might have helped. My vet pretty much just taught me how to inject and left me alone, so the advice I was getting from reading posts on the Health board was my education, and then I moved over to the TR board. I am pretty sure that the various factors, like diet, my confidence with allowing the process to unfold w/o freaking out, have stabilized and I can commit to the TR. I know it must try your patience when you give your valuable time to give advice and then it goes unheeded. Truthfully, not everything that you say to a newbie sinks in all at once!

Also, one small comment: the use of the "color" black as code on the spreadsheets for above 500 numbers doesn't help newbies. When I saw black, and then saw Terra's BG was in that range, my thought was "Oh God, that means she's going to die!" I have now learned that she can survive bouts of above 500 and even above 600 (meter pegged) without dying. It would help to not see black at first when you don't know anything except that this is a serious condition.

Thanks for your help today.
 
Karen & Terra said:
I did not leave home this afternoon without getting a second test. I knew it would be foolish to leave if she was dropping, but the second test, 15 min. later, showed that she was holding steady. From reading a number of condos here I notice that people test for trends as well as absolute numbers. If her second test had been lower, I would've stayed home with her.
Click to expand...
Let me provide a bit more education/information. I want to refer you back to the sticky on handling low numbers.
If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)

  • Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of food with high carb (HC) gravy or HC food only. (If you have a cat with GI issues, using syrup plus LC food is an alternative.)
  • Test again in 15 – 20 min. Depending on the numbers, give more HC food.
  • Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
  • Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
  • Test in an hour and follow the same steps.
DO NOT become complacent. If numbers have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.
Click to expand...

In part, since you are still new at this and we are beginning to see how Terra is responding without dry food in the picture, we still don't have any idea how she responds to HC food. It may be that she's very carb sensitive and her numbers will stay up with only a small amount of HC food. Or, she may be a cat that needs a good amount of HC food in order for her numbers to rise. Or, she may just bobble around. We just don't know.

In addition, getting only one subsequent test doesn't tell you whether Terra's numbers were stable and it was safe for you to leave. That's why, when I was writing the managing low numbers guidelines, I wanted to underscore that thinking that it is OK to stop monitoring after getting only one test may not be the best decision.

I know there's a lot to absorb. Sometimes, what you need to do is not always intuitive.
 
Good job today, Karen! I'm pretty new and had an exciting day (or actually an exciting couple of weeks). We found out (by providence, really) that Simon did even better on less insulin. He was a pretty bouncy kitty when we first started, and that was only a month ago! I know that the more knowledgeable folks on the board will help you figure all of this out. I only have experience with one cat so far and I know ECID.
:thumbup

Here's a kitty to go with your "green" day. Now Terra, the green numbers are nice but try to stay just a smidgen higher!
 

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