Low AMPS, but skyhigh PMPS - What dose?

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Hercule's mum said:
Now if I could just magic away his diabetes...
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If only! :smuggrin:

Hercule's mum said:
I like the format of your spreadsheet better, especially with the clear labels for different numbers; but I gues we moved on from this for some good reason?
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Saoirse's spreadsheet is a custom jobbie that I developed over time for a few reasons:
  • I have PTSD and I can't hold information in my short term working memory or plan things any more and my brain gets completely overwhelmed and shuts down if I try to process stuff in real time so I gradually tweaked the spreadsheet to do all the heavy lifting for me to monitor her trends, etc. (The 7-day averages are particularly helpful.)

  • Again due to the anxiety disorder, the colour coding in the FDMB standard issue spreadsheet freaks out my nervous system (bizarre, but unfortunately true) so I had to change that.

  • I had to manage Saoirse's diabetes alongside chronic pancreatitis and later stage II CKD so it was necessary to keep track of clinical signs, food and water consumption, plus umpteen meds and supplements. The custom spreadsheet helped me to spot patterns of what did or did not agree with her - and also to backtrack to what had worked better in the past.

  • I used an Alphatrak 2 glucometer plus I'm in the UK (using SI units) and I couldn't get my head round the ranges in the FDMB standard spreadsheet. I found it easier to set up the BG ranges to suit my own needs. Also, despite being a cognitive disaster zone these days I am still a dyed-in-the-wool control freak (background in engineering and project management). I desired a more nuanced view of Saoirse's BG status, hence the additional ranges at the top of the sheet.
The FDMB sheet is great for most people's needs, and anyone can use it without any prior experience of using a spreadsheet. For my situation, the over-engineering was driven by necessity - I'd never have been able to care for Saoirse properly without it - but the design of Saoirse's sheet does require a certain familiarity with spreadsheet functionality in order to maintain it. Horses for courses.

Saoirse was wonderful when she went into remission. Sadly it didn't hold for long. I wanted to keep her on a single droplet of Lantus once a day (AM cycle) because it was just enough to support her little pancreas and calm the inflammation. Our own vet had agreed in principle to this approach, given that I am at home all the time to monitor her (housebound) and by that stage he had complete confidence in my ability to keep her safe (he regularly reviewed the 'brief' spreadsheet). Regrettably Saoirse was then referred to an internal medicine specialist and she hadn't a clue about using Lantus or tightly regulating feline diabetics. Legally in the UK she had higher authority than my own vet about what treatments Saoirse was allowed. She decided that Saoirse could not go back on insulin until her BG levels exceeded 11.1mmol/L (over the frelling renal threshold!!!) because, according to her, it is not safe to give insulin to a feline diabetic with a BG lower than this. My own vet's hands were completely tied. He wasn't exactly happy about the situation. I can still see the regret in his eyes as he apologised to me...

That woman was provided with ALL of Saoirse's BG data, clinical signs, etc., but arrogance trumped evidence and within 6-8 weeks Saoirse's pancreatitis started to worsen again, her clinical signs disimproved and her BG levels started creeping up. I had to wait until her blood sugar was so high it was spilling into her bladder before my vet could legally prescribe insulin for her again. It took months. Saoirse paid a very high price for that woman's intransigence... :( :mad:


Mogs
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Oh, How horrible Mogs! That seems so insane! poor Saoirse!

It is quite difficult to get a constant vet, left alone a good one. I am also in the uk, and live in a small city, but all the vets are big companies now with dozens of vets. Thankfully, we saw one hat has agreed to keep email contact and she is trusting me so far.

I 100% agree with the colours in the chart, they make me anxious too! If it ever up to vote, I'll vote for your! But no, I am very grateful I found the forum and all the help. It has made a huge difference. Hercule's bounce big time again, but I am getting used to it and not freaking out....:)
 
Hercule's mum said:
all the vets are big companies now with dozens of vets
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B****y capitalism. :rolleyes:

Hercule's mum said:
It is quite difficult to get a constant vet, left alone a good one.
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You never said truer.

I've had dealings with dreadful, bad, average, wonderful and astoundingly good vets down the years. Realistically, as in any walk of life, some are better in their field than others. The trouble with medical specialists - human or veterinary - is the cost when they don't get it right.

I live in a rural town so we still have more 'traditional' practices here (and long may that continue). Our main vet is an absolute topper: really collaborative, progressive in attitude to treatment, highly approachable and open to discussion on treatment choices, very kind and caring - and he had a sugar cat himself until recently! Overall, the vets at the practice are happy to work in partnership with clients, not like some holier-than-thou types.

I'm very glad to hear you've found a vet who's collaborative. Makes a huge difference, especially as diabetics can be frequent flyers! ;)

In case no-one's yet mentioned it to you, should you so desire you can share Hercules' spreadsheet with your vet. Provided the permissions are set up OK in the spreadsheet you can just email them the link and they can view it (no need for them to have a Google account). Both my vet and myself found it really helpful to do so.

Hercule's mum said:
I am very grateful I found the forum and all the help. It has made a huge difference. Hercule's bounce big time again, but I am getting used to it and not freaking out....:)
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I, too, am beyond grateful for this place. The members here are wonderful, and helped to save Saoirse's life on more than one occasion (and what's left of my sanity). I will be eternally grateful to the members here, and I will never be able to repay or pay forward all that they have given to me and to my beloved girl...

I'm glad you found FDMB. :)

It's one thing to read about diabetes in a book or on a website but it bears little relation to the lived experience of managing the disease day to day. It is both a reassurance and a great comfort to know there are people here who are that little bit further along the path and who are ready and waiting to hold your hand and show you the way any time you need it.


Mogs
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Hercule's mum said:
would a lower dose lead to a more "rolling hills" kind of situation because it reduces bounces?
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It might help. A lower dose that doesn't bring him as far down may help tamp down the bounces a little, but it probably won't eliminate them.It's not just "too low" as in lime green, it's "too low" as in what Hercule is used to.

Just takes time for him to get used to lower and lower numbers. At least the bounces seem short!
 
Hercule's mum said:
But do you have any idea why is his BG so all over the place, sharp drops, sharp peaks....
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He's a cat! ;)

Hercule's mum said:
would a lower dose lead to a more "rolling hills" kind of situation because it reduces bounces?
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Being serious now, your instincts here are good. This can be the case with some cats, though not all (I'm lookin' at you, trampoline junkies). For example, sometimes you can get a situation where for one of the day's cycles the cat is high enough at preshot to dose safely but is too low at preshot to dose on the other cycle. Tweaking the dose to lower it slightly can in some cases lead to the cat having high enough preshot BGs on both cycles to enable safe dosing. Granted the nadir might not be as low as with the higher dose but ijt's better for the cat to run slightly higher than to skip doses altogether.

While there are typical patterns of response to particular insulins, only time and testing will reveal how a given insulin will affect a particular cat. There are two really key things that make tracking spreadsheets so valuable. First, they help us keep our kitties safe. Second, they help us mere humans to 'learn' our cats. :)


Mogs
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Nothing much to add to the information that @Nan & Amber (GA) already provided on the Prozinc dosing protocols. The Prozinc dosing protocols were expanded and rewritten in February 2020. Lots of good detail there now.
Nothing much to add to the information that @Critter Mom provided.

You 2 have it covered, and covered well.

The reduction to the 0.75U dose was because your cat had dropped into those neon green BG numbers, which told us the dose was a bit too high. That lower 0.75U dose should be held for a bit. Not increased back to 1U unless the bounces don't clear and the BG levels get too high and don't come back down at mid-cycle.

If you see another neon green number, (like you did today 8/5/20 on the 1U dose) that is another automatic 0.25U dose reduction. Please, please take those dose reductions when the BG levels are telling you the dose is too high. Let's keep Hercules safe from a hypo. Yes, he is bouncing sky high. But you recently changed the food fed too, to a lower carb option. Since you did not see the recommendation to lower the dose from 1U to 0.75U and gave the 1U dose this morning 8/5/20, that would not be another automatic dose reduction. Let's see what Hercules looks like in the morning at AMPS or at PMPS tomorrow, 8/6/20.

See the Prozinc ISG group, the stickies at the top for more specific Prozinc information. Lots of good reading there. Don't expect to take it all in at once.

p.s. New thread please? This one is getting long and the message board works better if the threads are shorter. Link this older thread in at the top of the new thread. Thanks.
 
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