Mala 10/26

I feel as though I'm posting a question mark by each and every title for every day, and as this isn't Mala's first time below a 40, I'm not comfortable putting up a 911 sticker.

She was dropped to a .5 yesterday, and that dose was maintained this AM. She was fed lc food at +2, +3, and as she was still falling at +4, she got mc food to keep her numbers up.

It's +5 and she's fallen below 40 again.

I have read through all the information I can find about charting, testing, feeding, and dosing, but have no idea whether this warrants another reduction. From comments from Marje yesterday, we should have been testing to catch the drop at +2 and feeding through onset. We did that today.

So is this another dose decrease?
 
Wow, Yemala has kept Max busy. Sorry I missed all this activity.
How is she doing now?
The sharks is below 50 on a human meter, below 67 on a pet meter. That's how I understand it anyway.
 
I see the 92. Great job Max! Enjoy your well earned rewards tonight! Definitely keep up the testing for at least 2 hours after going below 50.
A 911 would have been warranted, I feel, but if you don't feel comfortable, maybe use the word "help" in the title to get more eyes on this while in the middle of the situation.
 
THIS, however, is the time when I need some expert input.

Having read through the advice from Marje from yesterday, she recommended feeding through the onset at +2, low carb food to help manage the curve.

Well, that's what we did today. She still fell into under 40 numbers, and we still had to feed her some medium carb food with honey to keep her from falling further.

There are days when we can do this. There are days when we CANNOT - such as Monday and Tuesday of next week, when all CGs will be busy and unable to check in. (I have to be at a vet clinic 30 miles from home by 7 AM both days to drop off boys for neutering or pick them up, then work from 9 until 8 PM.)

where do we go from here? what is a reasonable dose to manage what will be happening in 4 days? We just reduced her dose to .5. Should we drop it again?

If you could hear the tone of voice that's in my head as I type this, I think you all would get the tenor of my frustration. That would be REALLY frustrated. I cannot seem to predict this girl, following advice and recommendations often results in the same exact thing as before. No change. either she's REALLY high in numbers, or she drops hundreds of points in a course of an hour and I'm trying to put honey into her mouth.

She didn't follow established patterns in 2011, she isn't following them now. Re-reading the comments from yesterday, I expected a bounce. Nope.

I can't help what would happen today had we actually shot that 55 AMPS a couple of days ago. Would the low numbers be even lower?

I don't see the patterns I'm supposed to watch for, I don't seem to be able to predict where she'll go next, and I fear I'm killing her.

this isn't a bike I know. It's a bike with spikes and flames coming out the back. It stalls out unpredictably, it farts fire. The brakes are intermittent, and the throttle is loose.
 
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It was not a medical emergency, no 911 was needed. Max did a fabulous job.
Hroswitha said:
She didn't follow established patterns in 2011, she isn't following them now.
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Darn torti's! :p

I would take the reduction. Sure it's only two cycles after the last one, but it was the 30's and a couple days after a skip. The other possibility is to see if you could find a dose part way between 0.5 and 0.25, by sneaking the dose down a little bit.

We learned something about Mala today. If you see big drops at +2, you might want to try higher low carb food (8-9%) or even medium carb food to try to put the brakes on. LC didn't really slow her down.
 
Wendy - I would LOVE to do that, but Mala won't eat that stuff. I have some Nature's Recipe pate in gravy, which is supposed to be 17% carbs. That would qualify as high medium, and she only barely nibbles it. And that's what Max fed today, and what i gave her yesterday with honey, but it barely budged her out of hypo-land.

Would it be reasonable to ignore the numbers from the first month of this trip to sugartown with Mala, and look instead at 2011?

I'm looking for patterns there which are similar to this week. Today and yesterday, she began the AM cycle around 200. Yesterday, she received a .75; today, a .5.

In 2011, look at 4/26 - 4/27. If there's a decipherable pattern, I'm beginning to see it there. I think Mala is headed to the falls, and I think this shows the way.

On 4/26, she received a .25 dose. We had dropped from .5 to .25 the week before, when she went from a 262 to a 99 in the course of one cycle. We wimped out on the PM dose that day, and went to .25 after that.

So when we saw Mala drop hard yesterday and bring a 55 at AMPS on a .75 dose, we skipped the AM dose and saw her bounce into the pinks by PMPS, but a .75 kept her surfing greens all night - just like on 4/21/2011.

On 4/26, she jumped into the yellows, and my notes indicate that she was out of sorts - not her style. She fell from the yellows into blues and greens within 2 cycles, and stayed there. We maintained the .25 dose for only 4 more cycles before we reduced - to .1, then 1 drop, then nothing.

While I have a LOT of trouble predicting Mala's numbers, I would like to propose that she's about to follow this pattern again. A string of blues and greens following a few early/late cycle yellows, two to three cycles, then ready to go back to the falls.

So depending on her PMPS number, I think we'll shoot a .25 instead of the .5. Wendy is right - this little girl wasn't moving much on lc or mc food and needed to be kicked into gear. A lower dose would be reasonable.

I don't know how comfortable we'll be shooting numbers at or under 100 even at a lower dose. Mala's numbers are not being predictable (unless someone else can show me a pattern I can't see). If I need to be thinking about doses for 3 days out, as I will NOT be available either the 30th or 31st, I would even go so far as to skip PM doses and only dose during the day, but maintain the .25.

I really need help determining strategy. If all the above is nonsense, please tell me that and fix my misconceptions.
 
All right. Apparently, we're winging it tomorrow. I have no idea what we're doing, what dose to give, or how to deal with her unpredictable numbers.

I am metaphorically throwing the damn bicyle across the ravine and walking from here on out.

We'll post on her SS, but posting here is getting us nothing and nowhere.

Yemala 10/26 HELP AMPS 230; +2 151*; +3 78*; +4 46*; +5 33*; +6 92; +7 102; +10 158; PMPS 182
 
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Mala doesn't eat gravy. We've tried, multiple times, but the only way to get gravy into her is with a syringe.

Not that it would help. I doublechecked the carb load on the pate my son fed her today, and it's 17%. That food, even with honey, barely budged her bgs.

She won't eat kibble either. For her, it's boiled chicken, Weruva, or similarly low carb stuff. She loves pate, but can't have it now as none of it is low enough in phosphates.
 
Her phosphorus levels are not to the point that any vet I've consulted would be willing to prescribe one. I have asked. Their concern is valid - binders cause constipation, which must be counteracted with other medications or we have to persuade her to eat yams. As I don't see that happening any time soon, I think we'd rather not.

But my essential question is about dosing. On Thursday, she dropped under 40 and had to be given the 17% carb food with honey, but it took far too long to bring her up. We dropped the dose from .5 to .25 today. This was after skipping a dose earlier in the week when she threw an AMPS of 55.

I know people here say that will shoot anything above a 50, but looking at Mala's numbers, that doesn't seem reasonable. In 2011, we nearly lost her to hypo and she dropped to 23. The last several days, she's been hypo and stayed low despite a low dose and a lot of food.

Last I heard, the prediction was that she would bounce today. Instead, hypo again. We dropped the dose, and she's in the blues. Do we stay at .25, or increase?

I can't even find a reasonably written and clear explanation of what a "failed decrease" looks like in a chart. How do I know when a decrease has failed? Is a PMPS after a decrease of over 200 symptomatic of a failed decrease? Is there a longer pattern to it? What should we be looking for? Is she about to bounce again, and if she were, how would I know that? What in the numbers would tell me anything useful?
 
I think you'd be totally justified to try shooting .25

If it ends up not being enough, we'll deal with that later, but it's more important to keep her safe for now, especially if you're not going to be able to test next week.

I think that although what Marje suggested works for most cats, she's proving that ECID.

For her, if you see her start to fall quickly, you might want to add a drop or two of honey earlier instead of waiting for her to drop too low.

Like today....dropping from 230 to 150 in 2 hours is a fast drop. I'd suggest adding a drop or two of honey at +2 and see if it slows her down. If it does, great....if she continues falling, repeat it

Does that sound like a reasonable plan?
 
Hroswitha said:
I can't even find a reasonably written and clear explanation of what a "failed decrease" looks like in a chart.
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Let me give it a shot....Let's say you decrease the dose. You hold that dose (unless she drops too low again)

What we hope for with reductions, is that they can continue to get into "good numbers" on the new reduced dose. If they do bounce high, we have to wait for the bounce to clear, but we still want to see them return to "good numbers" within 6 cycles.

If they don't return to "good numbers" after the reduction, or they go up and stay up, it's a failed reduction.
 
At +2 this AM, when I got the 150, I got my son up and instructed him on testing and feeding for the rest of the AM.

She got her first 17% carb food at +2; she got more with honey at +3. She got it again at +4, but was no longer interested in eating it. The medium carb food barely moved her with a dose of .5, thus the decreased dose this PM to .25.

Tuesday and Wednesday of this week, I have to take foster kittens to a town 30 miles from here for neutering. They have to be there by 7. Then, back in time for tutoring and then, work until later. Max will be home on Mondays and Wednesday, Dave can check in, but not often enough.

It seems that doses we shoot today have consequences in several days. Am I wrong? I just don't get the science in this stuff.
 
You're not necessarily wrong....Lantus usually takes 2-3 cycles (at least) before we really know what it's going to do.....that's why we hold the same dose for at least 6 cycles so the depot settles and we really know what's going on.

With her, she's reacting in an unusual way, so we have to figure out what will work for her.

But right now, she's had so many dose changes, it's hard to know what's going on. That's not your fault at all....it's what you needed to do.

That's why I'm suggesting we try the .25 for the next few days and see how she does.
 
Thank you for that explanation. Last time we used the board, we barely dipped our toes into the water before she was off the juice. I know she's not considered a "new diagnosis", but we never even thought of her as an old diabetic before I was told that she is. So seeing numbers under 50 was shocking, particularly since we've seen her get a low number, get a dose, and drop into hypos and have to be force fed honey and ice cream.

Under 40 feels dangerous to me.

On the plus side, she gave us her first "post-poopial prance" this evening, complete with a roar of defiance perched on the dining room table. We haven't seen that in several years.
 
Chris & China said:
But right now, she's had so many dose changes, it's hard to know what's going on. That's not your fault at all....it's what you needed to do.

That's why I'm suggesting we try the .25 for the next few days and see how she does.
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Have you looked at her numbers from 2011? In three days, she had two dose decreases. She stayed at .25 for 8 days, before we started dropping her again to a .1, then a drop. On 4/30, she had an AMPS of 53, and we didn't shoot, but she stayed in the blues and greens. We only dosed her a .1 for one cycle.

She's a mess.
 
Hroswitha said:
I know she's not considered a "new diagnosis", but we never even thought of her as an old diabetic before I was told that she is
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Yeah, new versus old is based on the date of diagnosis, not how long they're on insulin

With cats that have come out of remission, we tend to be a little more aggressive to try to get them back into remission....that's why we say not to reduce until they've dropped below 50 three times, or dropped below 40 once.

But she dropped below 40 today, so she's earned the reduced dose either way!
 
Hroswitha said:
She's a mess.
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No....she's a cat ;)

We've tried to get them to read the rule book but they fake illiteracy really well :banghead:

We really can't go by what she did in 2011....it would be nice if we could because then she'd be OTJ again soon!!

She's 7 years older....everything in her body is going to work differently than it did then.
 
She dropped below 40 today and yesterday. And stayed there for longer than I liked. And this would be number 3 under 50 in the last week.

So .25 tomorrow, and see where we are.

So lucky to have a teen boy at home who can step up.
 
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