Lucy Curve Today!
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Sue and Oliver (GA)
Very Active Member
Hmmmm. Looking interesting, Joan. Can't wait to see the rest of the day.
Rob & Harley (GA)
Very Active Member
If this turns out to be an inverse curve, I'm voting to try the sliding scale again.
C
Carl & Polly & Bob (GA)
Guest
When, and how much, did Lucy eat?
Carl
Carl
123joan
Active Member
Lucy ate one and a half cans of FF Tender Beef Classic at 5:45 am. I tested her BG at 5:45, fed her, then gave her the insulin at 6:00 am. I've given her a treat after each BG test consisting of two or three flakes of water packed tuna, which equals about an eighth of a teaspoon each time. I feel I have to give her a treat after she comes obediently waddling into the kitchen each time she hears the meter beep.
Her regular feeding schedule is 1.5 cans FF am right after AMPS, and usually a quarter can a half hour later. Skipped the quarter can this morning, just because I had to leave in order to get back for the CURVE schedule. So only thing different today is the tuna treats.
Her regular feeding schedule is 1.5 cans FF am right after AMPS, and usually a quarter can a half hour later. Skipped the quarter can this morning, just because I had to leave in order to get back for the CURVE schedule. So only thing different today is the tuna treats.
C
Carl & Polly & Bob (GA)
Guest
OK, great info. I was trying to rule out food as the reason her numbers have gone up instead of down. You just ruled that out! The tuna treats are not going to boost her BG much if at all.
I don't think we're seeing "bounce" here, because where is the low that resulted in the high?
OK, Lucy, so what's up then?
I don't think we're seeing "bounce" here, because where is the low that resulted in the high?
OK, Lucy, so what's up then?
123joan
Active Member
I have no idea what she is doing. I'm doing a good job keeping track, but what can I do with the info? Scratch my head!
I had Lucy in for a checkup last week, (wanted her teeth checked out and they are just fine) and our vet thought Lucy might need to go up a half unit. She asked me to do a curve checking every two hours and let her know the numbers. She thought I might be missing the nadir. But also mentioned Somogyi effect. This is going over my head again
AMPS 206
+2 274
+4 265
+6 295
+8 297
+10 263
I had Lucy in for a checkup last week, (wanted her teeth checked out and they are just fine) and our vet thought Lucy might need to go up a half unit. She asked me to do a curve checking every two hours and let her know the numbers. She thought I might be missing the nadir. But also mentioned Somogyi effect. This is going over my head again
Do you mean that in order to see a bounce she would have had to show a low number in the last cycle? I don't understand, and I won't be able to concentrate on this tonight, will have to wait until tomorrow to read and digest the latest. Though I will be tempted to.
AMPS 206
+2 274
+4 265
+6 295
+8 297
+10 263
C
Carl & Polly & Bob (GA)
Guest
OK, you get what I mean by "bounce", right? That a low BG that is not necessarily dangerously low, will cause her pancreas and liver to dump "sugar" into her blood instinctively. That can happen if she goes from whatever levels her body has become used to, to a level that her body feels is "too low" for comfort. It seems the only way to get past that is for the body to see the low numbers more often, so it "relearns" what normal is.
You may have read terms like "liver panic" or "liver training"? Another thing people say is that "kitties bounce until they don't".
So when I say that I don't see this as a bounce, it's because I'm not seeing any low numbers that would cause her pancreas and liver to react in this way. Now, no, that doesn't mean it isn't happening. We can't monitor BG 24 hours a day. But when you are testing every two hours, I would expect to see some "meter" evidence of low numbers that might explain the higher numbers that follow.
Vets and others like to use the term "Somogyi", but it gets way overused. Dr. Somogyi was born over a hundred years ago. He was the first doctor to administer insulin to a child, back in the 1920's. He developed the theory that excessive insulin resulted in higher blood glucose in diabetics. The important thing is that this theory is not proved, it's still considered a "theory".
Even if we agree that low numbers can trigger a response from the body that results in higher BGs after the lows, it says that the hypoglycemia is prolonged and untreated. I don't see numbers on Lucy's SS that indicate that any low numbers have been prolonged. As far as untreated goes, what do we do when the numbers go low? We feed them, right? Or we rub karo on their gums. The only way to "treat" low BGs is to force them to go up. If you saw Lucy drop into green numbers well before her nadir, you'd feed her to slow or stop the drop in BG, correct? So we don't let hypoglycemia remain untreated. Not unless it happens for a prolonged period when we aren't at home to test them.
Looking at Lucy's SS, since September, there's only one entry that is green. And where the heck that number came from, I have absolutely no idea. But nothing that would indicate low numbers for an extended period of time.
There are things we don't know. Not sure what goes on during the wee hours of the morning. BUT, if I look at her daytime cycles, and how she responds to the morning doses, there's nothing that makes me think that the nighttime cycles are extremely different. Could she go lower overnight? Sure, but I don't believe she goes that much lower.
Bouncing, other the other hand? Yes, she bounces. When I say "bounce" it isn't a chronic thing. It is what I described earlier. A quick instinctive boost to her BG going low that results in a high preshot the next cycle. If I look at 10/14's PM number, I can believe that overnight, she went low enough to cause a bounce, and she gave you an ugly red AMPS on the 15th. That looks like a bounce to me. The night of the 15th, you reduced to .8u, and over the course of the next couple of days, her morning numbers got better. By the morning of the 17th, she was giving you an AMPS that was right where the PMPS was the night before.
I think her thinking you might be missing the nadir was a good thought, and having you check every two hours was a good idea. But today, Lucy didn't show you a nadir. It looks like the insulin didn't do much of anything. If anything, the curve is upside down or inverse. A frown instead of a smile.
There are two reasons, unfortunately, for an inverse curve. One, I think, is obvious. Not enough insulin. That's why I asked about when she ate. If she had eaten at +4 or later, and her numbers went up, that would explain the increase in the middle of the cycle. So would not enough insulin. She ate in the morning, the insulin had little effect, so her numbers went up and just hung out there. Once the food was gone from her system, there's no food continuing to push the BG up, and the insulin would be wearing off. So the numbers aren't going to rise much more, but they aren't going to drop much either. They just sit there.
She ended the 12 hour cycle right where she was at +2 when the BG was higher from breakfast.
The other theory is that an inverse cycle is caused by too much insulin (see why this diabetes thing is soooo much fun? Two completely opposite explanations for the same thing!). The problem I have in agreeing with this theory is that I think that it is dependent on a "chronic" type of situation. That her insulin dose needs to have been too high for too long, and causes a chronic internal body reaction to numbers that were low and it just keeps dumping sugar into her system. I don't see that data on the SS.
To me, it looks like "not enough insulin", but let's see what your vet thinks regarding the .5u increase. I happen to agree with her, but others may not. I think by advising an increase of .5u, your vet is trying to see if a "big" increase will show a result one way or the other. Either she's hoping for an obvious drop in BG (which would indicate that she is right), or further evidence that "somogyi" is what she's seeing. I think you should ask her if she's talking about a short lived boost in BG, or a long-term run of higher and higher numbers when she says "somogyi". One is chronic, and the other isn't.
I know that is a lot of stuff to take in when you don't feel you can concentrate tonight! But read it a couple times tomorrow before you talk to the vet again. :smile:
Carl
You may have read terms like "liver panic" or "liver training"? Another thing people say is that "kitties bounce until they don't".
So when I say that I don't see this as a bounce, it's because I'm not seeing any low numbers that would cause her pancreas and liver to react in this way. Now, no, that doesn't mean it isn't happening. We can't monitor BG 24 hours a day. But when you are testing every two hours, I would expect to see some "meter" evidence of low numbers that might explain the higher numbers that follow.
Vets and others like to use the term "Somogyi", but it gets way overused. Dr. Somogyi was born over a hundred years ago. He was the first doctor to administer insulin to a child, back in the 1920's. He developed the theory that excessive insulin resulted in higher blood glucose in diabetics. The important thing is that this theory is not proved, it's still considered a "theory".
Here's what I find important with his theory - (highlights are mine)
Even if we agree that low numbers can trigger a response from the body that results in higher BGs after the lows, it says that the hypoglycemia is prolonged and untreated. I don't see numbers on Lucy's SS that indicate that any low numbers have been prolonged. As far as untreated goes, what do we do when the numbers go low? We feed them, right? Or we rub karo on their gums. The only way to "treat" low BGs is to force them to go up. If you saw Lucy drop into green numbers well before her nadir, you'd feed her to slow or stop the drop in BG, correct? So we don't let hypoglycemia remain untreated. Not unless it happens for a prolonged period when we aren't at home to test them.
Looking at Lucy's SS, since September, there's only one entry that is green. And where the heck that number came from, I have absolutely no idea. But nothing that would indicate low numbers for an extended period of time.
There are things we don't know. Not sure what goes on during the wee hours of the morning. BUT, if I look at her daytime cycles, and how she responds to the morning doses, there's nothing that makes me think that the nighttime cycles are extremely different. Could she go lower overnight? Sure, but I don't believe she goes that much lower.
Bouncing, other the other hand? Yes, she bounces. When I say "bounce" it isn't a chronic thing. It is what I described earlier. A quick instinctive boost to her BG going low that results in a high preshot the next cycle. If I look at 10/14's PM number, I can believe that overnight, she went low enough to cause a bounce, and she gave you an ugly red AMPS on the 15th. That looks like a bounce to me. The night of the 15th, you reduced to .8u, and over the course of the next couple of days, her morning numbers got better. By the morning of the 17th, she was giving you an AMPS that was right where the PMPS was the night before.
I think her thinking you might be missing the nadir was a good thought, and having you check every two hours was a good idea. But today, Lucy didn't show you a nadir. It looks like the insulin didn't do much of anything. If anything, the curve is upside down or inverse. A frown instead of a smile.
There are two reasons, unfortunately, for an inverse curve. One, I think, is obvious. Not enough insulin. That's why I asked about when she ate. If she had eaten at +4 or later, and her numbers went up, that would explain the increase in the middle of the cycle. So would not enough insulin. She ate in the morning, the insulin had little effect, so her numbers went up and just hung out there. Once the food was gone from her system, there's no food continuing to push the BG up, and the insulin would be wearing off. So the numbers aren't going to rise much more, but they aren't going to drop much either. They just sit there.
She ended the 12 hour cycle right where she was at +2 when the BG was higher from breakfast.
The other theory is that an inverse cycle is caused by too much insulin (see why this diabetes thing is soooo much fun? Two completely opposite explanations for the same thing!). The problem I have in agreeing with this theory is that I think that it is dependent on a "chronic" type of situation. That her insulin dose needs to have been too high for too long, and causes a chronic internal body reaction to numbers that were low and it just keeps dumping sugar into her system. I don't see that data on the SS.
To me, it looks like "not enough insulin", but let's see what your vet thinks regarding the .5u increase. I happen to agree with her, but others may not. I think by advising an increase of .5u, your vet is trying to see if a "big" increase will show a result one way or the other. Either she's hoping for an obvious drop in BG (which would indicate that she is right), or further evidence that "somogyi" is what she's seeing. I think you should ask her if she's talking about a short lived boost in BG, or a long-term run of higher and higher numbers when she says "somogyi". One is chronic, and the other isn't.
I know that is a lot of stuff to take in when you don't feel you can concentrate tonight! But read it a couple times tomorrow before you talk to the vet again. :smile:
Carl
Rob & Harley (GA)
Very Active Member
If you decide to go with your vets dose increase (we call that a bam dose) be sure to do it on a day that you will be able to test through it like you did today in case you need to intervene with food.
123joan
Active Member
Our vet wants me to go up to a "skinny 2". She is so leery of the U-100 syringe conversion, I didn't do a good job allaying her fears over the telephone. She didn't think Lucy's numbers were that bad, though she'd like to see them lower.
So is 1.8 = skinny 2? I'll have to grab some U-40 syringes and look at them. Forgot what they look like.
I can be home to test morning and late afternoon but will be gone mid-day. Of course I'm a little nervous about upping that dose. I have gravy food on hand. How low would she have to go before I did any intervention? Obsessing again. I won't up it tonight, will wait till tomorrow.
Thank you everyone for helping Lucy and me!
Lucy is carefully watching the cursor move along on the laptop screen. She knows I'm writing about her, I'm sure.
So is 1.8 = skinny 2? I'll have to grab some U-40 syringes and look at them. Forgot what they look like.
I can be home to test morning and late afternoon but will be gone mid-day. Of course I'm a little nervous about upping that dose. I have gravy food on hand. How low would she have to go before I did any intervention? Obsessing again. I won't up it tonight, will wait till tomorrow.
Thank you everyone for helping Lucy and me!
Lucy is carefully watching the cursor move along on the laptop screen. She knows I'm writing about her, I'm sure.
C
Carl & Polly & Bob (GA)
Guest
I would say 1.8 would equate to a skinny 2.0. Don't understand why the vet is leery of the U100 conversion. It's just simple math. U40 dose x 2.5 = what it looks like in a U100 syringe. How hard is that? :lol:
You could do a show and tell with them. Take a tiny thimble sized container, fill it with water. Draw up 10 units in your U40 syringe. Squirt it back out into another tiny container. Have her draw it up into a U100 syringe. Bet her 10 bucks it reads "25" when she's done. Easy money!
As far as "how low she goes"...
You want to watch not only for the amount of drop, but the rate of drop. PZI usually kicks in by +2 or +3. If you start at 300, and test at +3 and she's dropped a large amount like 150 points, then she's dropping pretty quick (50 points an hour), and she's still got 3 hours till her theoretical nadir time. So you would want to slow it down by feeding at +3. 150 is perfectly safe, but that's a fast drop. You don't have to break out the HC food and karo, but you could give her a couple spoonfuls of normal food to slow things down. It really depends on when in the cycle you see the low numbers. That determines which can of food you need to open.
What hours are you talking about tomorrow? I think you're an hour behind me? What time is shot time? I'm off tomorrow, and I can "hand-hold" you through this unless you're getting up before the sun. :lol: Give me an idea when you'll be shooting, and how long after that you'll need to go out, when you'd be back, etc. (I do this sort of thing in Lantus TR fairly frequently. Usually it happens - low number questions - in the late night/wee hours, and I've pulled some all-nighters on occasion. ;-) )
Not only does Lucy know you're writing about her....she's probably sending you telepathic impulses that are directing your fingers on the keys.
Carl
You could do a show and tell with them. Take a tiny thimble sized container, fill it with water. Draw up 10 units in your U40 syringe. Squirt it back out into another tiny container. Have her draw it up into a U100 syringe. Bet her 10 bucks it reads "25" when she's done. Easy money!
As far as "how low she goes"...
You want to watch not only for the amount of drop, but the rate of drop. PZI usually kicks in by +2 or +3. If you start at 300, and test at +3 and she's dropped a large amount like 150 points, then she's dropping pretty quick (50 points an hour), and she's still got 3 hours till her theoretical nadir time. So you would want to slow it down by feeding at +3. 150 is perfectly safe, but that's a fast drop. You don't have to break out the HC food and karo, but you could give her a couple spoonfuls of normal food to slow things down. It really depends on when in the cycle you see the low numbers. That determines which can of food you need to open.
What hours are you talking about tomorrow? I think you're an hour behind me? What time is shot time? I'm off tomorrow, and I can "hand-hold" you through this unless you're getting up before the sun. :lol: Give me an idea when you'll be shooting, and how long after that you'll need to go out, when you'd be back, etc. (I do this sort of thing in Lantus TR fairly frequently. Usually it happens - low number questions - in the late night/wee hours, and I've pulled some all-nighters on occasion. ;-) )
Not only does Lucy know you're writing about her....she's probably sending you telepathic impulses that are directing your fingers on the keys.
Carl
123joan
Active Member
It's shortly after 9:30pm right now, we are in eastern time zone.
Shot time is between 5:30 and 6:00 am. I shoot (no pun intended) for 5:45.
I will be home until noon, and back before 4:00.
I'll feed them right after BG and shot. So I will test right around 9:00 am, unless it's a good idea to test at +2?
Glad I stocked up on test strips this week!
I'm sure our vet will be fine with the syringe conversion issue after we talk about it in person. I think she is worried about a mixup and that is what concerns her.
I wish I knew when Lucy's theoretical nadir time is, as far as I can see there is no pattern.
I'll start a new thread in the morning. THANK YOU!
Shot time is between 5:30 and 6:00 am. I shoot (no pun intended) for 5:45.
I will be home until noon, and back before 4:00.
I'll feed them right after BG and shot. So I will test right around 9:00 am, unless it's a good idea to test at +2?
Glad I stocked up on test strips this week!
I'm sure our vet will be fine with the syringe conversion issue after we talk about it in person. I think she is worried about a mixup and that is what concerns her.
I wish I knew when Lucy's theoretical nadir time is, as far as I can see there is no pattern.
I'll start a new thread in the morning. THANK YOU!
C
Carl & Polly & Bob (GA)
Guest
I think the +3 (9am) is a good idea, and I'll set an alarm to make sure I'm at a computer at that time to see what you see. Once you see the +3, you'll have an idea of what time makes sense for the next test. Big assumption, but if the nadir is around +6, you'll be able to test just before you leave. And we can figure out if, or what kind of food could be left out in case she wants a snack while you're gone?
Anything could happen Joan. You might see a good reaction to the increase, or Lucy could just be flat, but there's only one way to find out. Regardless, it's a good idea to keep in mind that it's just one cycle, one snapshot in the big picture. I'm just hoping she shows you something!
Carl
Anything could happen Joan. You might see a good reaction to the increase, or Lucy could just be flat, but there's only one way to find out. Regardless, it's a good idea to keep in mind that it's just one cycle, one snapshot in the big picture. I'm just hoping she shows you something!
Carl
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