LOW AGAIN 10/2 Chester's PMPS 238,+4=165,+6=84

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Jaye and Chester

Jaye and Chester

Member Since 2010
This is an amazingly low amps for us. I tried the lowered dosage last night but had no food out for him. Not sure I like that idea, but he certainly didn't get too high. I'll be doing some pretty intensive testing today and tomorrow, I think.


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Re: 10/2 Chester's AMPS 189,+2=375,+4=290

Yes, it was nice while it lasted. *sigh*

I slept through the +1 and was woken up to an ugly +2. Not sure how all this is going to work out.

Question: what does one do when it seems that the cat should be between 1.5 and 1.25? 1.5 with small snacks leaves him high, 1.25 w/o snacks leaves him high as well. I HATE to up his insulin (almost feels like a failure to me, since we've been trying to lower it but...oh, well...)

My plan was to leave him at 1.5 and not give snacks, just to see how low he would go on his own, but his last two pre-shot numbers made me hesitant to do that. So down to 1.25 he went, but now his numbers are stinky.

Then again, he takes several days to iron out.

Feeling the frustration creeping in again (and I'm on my LAST chocolate doughnut...NOT good!)

He's looking good and is as happy as a clam this morning, though!
 
Re: 10/2 Chester's AMPS 189,+2=375,+4=290

Morning Jaye and Chester - I've seen the experts say "sometimes you have to go up to go down." don't look at it as a failure, his pancreas is not well yet so he's not ready for his dose to go down. don't be bummed. ;-)
 
Re: 10/2 Chester's AMPS 189,+2=375,+4=290

Ah, the trouble is that I already lowered his dose last night to 1.25, both on vet advice and by looking at his pre-shots which were low enough that I was uncomfortable shooting the higher number. I'm really bummed because this was my weekend to do a curve with the 1.5 and that's been shot to H*ll...
 
Re: 10/2 Chester's AMPS 189,+2=375,+4=290

Hi Jaye

I'm hoping others will chime in too with that question, but in my own experience, feeding small snacks thru the early part of the cycle was highly recommended.
Plus a late cycle snack around +8/+9 can really help support the numbers.


With my own kitty, with data collecting and experimenting I learned to see his patterns a bit more clearly by spreading out the snacks as suggested to me here in LL.

This was our schedule and still is to this day:
Luna eats one 5.5oz can a day...I split that can up like this:
AMPS breakfast, +1, +2, +3 take a portion of that can and split it up to smaller snacks thru those hours...snack again at +6 sometimes, and a snack at +9...then the whole thing again for the PMPS cycle
(Keep in mind, I was home during his time on insulin and it was easier to do this, plus I lost a lot of sleep and a bit of my mind :lol: )

ECID applies here (every cat is different) so you may want to track, on days that you can, how food influences Chester.

It is frustrating, but over time, it does start to show you some results. It's just part of the learning curve we have to go thru.
You also want to keep in mind, the nadir's which can tell you a lot, try to get one today around +5 and +6...also Lantus likes consistency, moving around in doses can mess up the numbers too. So giving each dose time to settle as suggested in the protocol stickie plays a big part too.

Feel better ok? This really does get easier! :YMHUG:
 
Re: 10/2 Chester's AMPS 189,+2=375,+4=290

Yes, I've definitely learned that Chester takes quite a while longer to iron out than I'm used to (with my dog, who is on NPH). He was solidly on 1.5 for 14 cycles, so I don't feel that I rushed a dose change. I just wonder if I changed in the right direction! If I kept him with snacks (which is just as difficult in my house as not feeding, because of all the other cats) then maybe upping the 1.5 would have been a better way to go. My vet did offer me the choice, either up his dose and continue the meals or lower his dose and fast between meals.

Meanwhile, Chester is dropping his lime-green feather toy at my feet and looking at me like, "Relax! I'm just fine...play with me!" (which, frankly, brings tears to my eyes as I think of our journey together so far).
 
Re: 10/2 Chester's AMPS 189,+2=375,+4=290,+5=239

Is your vet taking nadir's into consideration?
Very sweet note on Chester there, that's what it's really about isn't it?
 
Re: 10/2 Chester's AMPS 189,+2=375,+4=290,+5=239

Ronnie & Luna said:
Is your vet taking nadir's into consideration?
Click to expand...

Definitely... My poor vet(s) are probably so tired of hearing from me, but they check in with me at least once a day and, even nicer, use the link to my spreadsheet and have that info available whenever they need it. Virtually every time I talk to them, one of them has just looked at my spreadsheet. Can't say enough good things about my vets.

The nadir...what an elusive concept! Wish I knew just where Chester's was. But I've been naughty and artifically stopping those late night drops with LC so I could sleep (and try to prevent big morning bounces) that his "true" lows are anybody's guess right now. Today I'll find one...hopefully...because I'm home but now that the dose has changed last night I don't hold much confidence in it telling me too much.
 
Re: 10/2 Chester's AMPS 189,+2=375,+4=290,+5=239

I can empathize -- it does sometimes feel like a defeat to have to raise the amount of insulin. On the other hand, if it supports our kitties' pancreas and gives it time to heal, it's a good thing!

From my read of Chester's SS, if it were up to me, I don't know that I would have reduced his dose. It looked like he was making progress at 1.5u. (I also don't think feeding him LC was aborting the cycle. LC will generally encourage a surf.) Maybe it's a matter of perspective but 189 is a great pre-shot number and not overly low. One of the differences between Lantus and other types of insulin is that once you're at lower numbers consistently, the curve actually flattens out. If you take a look at Achilles SS (he's on an OTJ trial), you'll see there's not much variation between pre-shot and nadir. When you start with a low number, once you're past the bouncing stage, Lantus can "latch" on and keep the numbers low. If you look at your PM cycle on 9/18, you shot a 132 with a dose of 1.75 and it was a gorgeous cycle!!

As for food, my perspective is much like Ronnie's. Feeding only once each cycle forces a newly healing pancreas to work a lot. It's got to be like eating Thanksgiving dinner twice a day. Spreading it out means the pancreas works a little bit over a longer period vs. working very hard all at once. To a large extent, how you use food throughout the cycle may depend on what Chester's needs are. Some kitties drop low early in the cycle, so food is spread out over a few hours in the beginning of the cycle. Other cats have different needs. It's a bit of trial and error to figure out what your cat's needs are.
 
Re: MORE Questions 10/2 Chester's +9=176

Thanks...everything you've said has made great sense...which brings up more questions!

Did I totally screw up by lowering him for two cycles. Can I raise him again tonight, because it's looking like he'll easily top 200 at pmps and leave a snack. The autofeeder is fired up, but I know I'll still be up checking.

Leaving him at 1.5 was my inclination for the weekend, but the lower numbers spooked me out of it. Guess I should have went with the vet's first recommendation of slightly upping his 1.5 and giving him snacks. Live and learn...unfortunately, it's always at Chester's expense. *sigh*

Another question is about the meter: I'm using AlphaTrak with him, so those gorgeous lows are actually quite a bit lower when one compares them to the Relion meter, which I just purchased for comparison's sake. He was a 176 on the AT but only a 112 on the Relion...same blood drop.

I was mainly using the AT so I could accurately compare with my vet, who uses the same thing. But since I don't bring him in for curves and can't see a reason ever to bring him in to the vet for another curve, I'm asking myself if it's worth the expense. If I go by Relion numbers, Chester is doing FABULOUSLY! :-D Of course, there's that $150 worth of test AT test strips on their way...but it will give me a long time for comparing, right?

Dadburn Wal-Mart gal gave me the Relion Confirm/Micro strips instead of just the Micro strips and I opened it before I noticed. It still worked (no error messages) so I'm hoping I'm okay with them.

So....dose tonight?
 
Re: MORE Questions 10/2 Chester's +9=176

Strips - my last ones also said Confirm/Micro and they've been just fine. no appreciable difference. they look identical, prolly are.

I started w/AT - too rich for my blood. somewhere on here I read there is a differential between human and AT meters, I don't know exactly, 30 points lets say, and if your vet knows that number, he can still apply your data taking the differential into consideration. And for us, evaluating trends has been as important as each individual number.

I must have told myself easily one million times - patience is a virtue.
 
Re: MORE Questions 10/2 Chester's +9=176

I have a long time to gauge the difference because I have 150 strips for the AT coming (which, unfortunately calculates to over $150). I think I'll put both numbers in my SS for now, but color code to the AT that I've always been using. Maybe I can switch my dog over as well (yup...two on the AT....pretty cost prohibitive).

That being said, they are clearly at least 40 lower, which means my 80s with Chester have been definitely earning him those dose reductions I had been giving him.

Will I screw him up if I go back to 1.5 tonight, pmps numbers willing, of course.
 
Re: MORE Questions 10/2 Chester's +9=176

Regarding the AlphaTrack vs. a human meter -- this is discussed in the link to the Dosing Protocol for Cats on Lantus/glargine or Levemir/detemir Using Daily Home Monitoring of Blood Glucose Concentrations to Adjust Insulin Dose in the "Dosing Protocol" sticky:
Queensland/Roomp & Rand Protocol said:
It is very important to note that blood glucose concentrations measured using a whole blood glucose meter calibrated for human blood may measure 30-40% lower in the low end of the range than glucose concentrations measured using a serum chemistry analyser or a plasma-equivalent meter calibrated for feline use. Therefore, if using a meter calibrated for feline use (eg. AlphaTRAK, Abbott
Laboratories, CA, USA), or a serum chemistry analyzer, add approximately 30 mg/dL (1.7 mmol/L) to the target glucose concentrations (see Table 3B). For example, a target > 50 mg/dL (2.8 mmol/L) becomes > 80 mg/dL (4.4 mmo/L) when using a meter calibrated for feline use. Instead of aiming for 50-100mg/dL (2.8-5.6 mmol/L) , aim for 80-130 mg/dL (4.4-7.2 mmol/L [round numbers 4.5-7.0 mmol/L).
Click to expand...

The bottom line is that when you get a number of 80 or lower on the AlphaTrack, Chester will earn a dose reduction. If you switch to the Relion, a BG of below 50 earns a reduction. My best advice would be to pick one meter and stick with it. Otherwise, you will drive yourself crazy.

Chester's numbers are not awful today by any means. You can go back up to 1.5u if you want. His numbers may be a little wonky from the close together changes so don't be concerned if they look weird. You won't have screwed up. It's OK if you want to hold the dose for a few cycle, as well.
 
Re: MORE Questions 10/2 Chester's +9=176

I personally don't think it makes sense to withhold food from a diabetic. Most human diabetics eat every few hours to try to keep their BG stable. It makes sense to allow cats to do the same.

There's no problem with going back up to 1.5 if you want to. Just call it a failed dose reduction and go back up to the last good dose.
 
Re: MORE Questions 10/2 Chester's +9=176

Thanks for the input, folks... My vet agrees as well and tonight we went back to the 1.5.

It sort of takes the pressure off in a way because I was always so concerned with him getting enough in the am and pm meal to last the whole day. Frankly, sometimes Chester isn't hungry enough to eat a whole day's meal in one sitting, then I was always worried about vomiting from gorging himself. This way he gets to snack and I don't have to always spend 30 minutes per meal coaxing him to eat.

Failed dose, eh? This site has a name for everything. I'm glad there's a pleasant euphemism for me screwing up a bit.
 
Re: MORE Questions 10/2 Chester's +9=176

it's not you, almost every cat has a time when they say "enough with the dose reductions!" and have to go back up in dose a little bit. Usually that kicks them back into gear so they can start getting green and earning reductions again. Look at Lucy's spreadsheet, she did it more than once.
 
Re: 10/2 Chester's PMPS 238,+4=165,+6=84

Great! Here we go again! Maybe the 1.25 wasn't such a failed dose after all. I gave him a bit of a snack tonight and some chicken breast when he wasn't crazy about his snack. Check him at +6 and he's 84 (AlphaTrak).

Maybe the optimal dose for Chester is 1.3333333333333 ? :-x

Gave him some more LC with some (what I assume) is HC gravy. Found a grain free packet called Soulistic (or something like that). The packet felt almost as if it was all gravy so I got a few. It was only after I gave it to him that I actually read the flavor. Tuna in Pumpkin Soup. How VERY disgusting sounding! Hope it works!
 
Okay, I'm going to try really hard not to over-react. I've already given him some LC food with some (presumably) HC nasty gravy on it, which he ate/lapped up. Retested and now he's 129. Think I'll let that ride for 20 minutes or so and retest before I give him anything more.

Good idea? Bad idea? Anybody out there?
 
Strangely enough...yes. It reminded me of a time when I was with my sister and her baby in Spain. We bought baby food in a jar and didn't know until we got back to her house and used the Spanish/English dictionary that it contained brains.

I bought three different packets from the same brand. Guess I should look and see what kind of "soup" the others are.

Testing again in 10 minutes.
 
Tuna in pumpkin soup? Yeesh!

Just keep in mind that an 84/61 is really OK. You are close to or at nadir. A bit of HC will definitely bump numbers up and you should be fine.
 
Is it okay if using an AlphaTrak, though? Pretty close to that magic dose reduction (again) cutoff.

I just retested (without giving any more food) and he's 148. Safe to go to bed, do you think? Kind of proud of myself. In the "old days" (only weeks ago) I would have pushed food and gravy for 30 minutes or more...maybe even reached for the Karo. I'm far too frustrated with high bounces the next morning to do that anymore.

Just checked the ingredients in the other pack I bought. Tuna & Salmon in Pumpkin Soup. What's the attraction of Pumpkin soup, I wonder. Do those people who market it actually think it sounds like it tastes good? Is it just my McDonald's mentality that doesn't see pumpkin soup as 'gourmet' but rather gross?
 
you're doing great, jaye.
thinking the pumpkin is supposed to aid with digestion and provide a little fiber/nutrients. sounds icky to me too, tho.
 
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