Misho 12/10 AMPS -504- advice needed

[Di&Misho]

Good morning everyone. I am back to your forum again with a question that bothers me lately.
Misho began to bounce very high at preshots. Usually this happens between +9 and next preshot. The thing is that he drops very rapidly after insulin shot, from his 400's and 500's pre shot numbers to yellow and even blue one at +4 . Didn't know what to do and last night I decreased his dose to 1.25U with a preshot of 524 and I thought this will help to not drop that low but again @+4 he was in his yellow 243 :?
I will be thankful to any ideas what throws him back to such high numbers at the end of the cycle. As I am not worried by the bounce itself but the very high numbers I see black one for the forth time this week . Is there anything you would advice me to do as to stop this steep dropping and hopefully the high bounce. Thank you for any thoughts you will share in our thread!

This is Misho's last thread at Relaxed Lantus .

 

[tibbs5]

hi Di
imho.....don't forget that the dose you shot last night is not really just that dose that you are seeing in his bg numbers. he is still using insulin from his shed so it may be 6 to 8 cycles before you see the effect of the dose change. i so understand what you are going through. our boys don't like to follow the rules. they are definitely making us practice patience. i hope you will see better numbers soon. :YMHUG: :YMHUG: :YMHUG:

 

[Sandy and Black Kitty]

Hi there Di

How is Misho feeling and behaving? Is his appetite good? Any other or new health issues? Any history of ketones?

let's check a couple basic items-

Please read this page for important information that may help you determine if your insulin is still good

Is your glucometer properly calibrated? If a special solution for checking meter calibration did not come with your meter, the manufacturer should be able to provide some so that you can check.

Is it possible that you may have some bad strips? If you see black again, immediately re-test or test yourself. Another option is to immediately re-test with your spare meter, if you have one. If you don't have a spare meter consider buying one as a back up. My kitty hid my meter once! (afterwards I made sure I had a spare).

It may be a good idea for you to try and get in the habit of testing some between PM+5 and PM+11. Just enough testing so that when you look at the ss there are not any 'wide open spaces" where data is absent. For example a +10 one night, a +6 another night, a +9 another night etc. It is very common for kitties to run lower on the overnight cycles and that may be the reason for the recent black AMPSs.

what was the reason for the decrease from 1.75u to 1.50u Dec 5/AM?

Do you maintain a consistent feeding schedule? if so, what are the amounts and times?

I saw in part I of Mishos story that he was on quite a high dose of a different insulin prior to Lev. Which insulin was that and did he ever have a symptomatic hypoglycemic episode during that time? The reason I ask this is that many kitties who experience symptomatic hypo become extremely sensitive to insulin.

Hang in there - and hang in here. Many experienced eyes available to try and help you figure out what may be going on

 

[julie & punkin (ga)]

I'm not sure what the issue is, but all I'm seeing on his spreadsheet is August 2014. I'm clicking on the link in your signature block. Can you repost the link to the current ss in US numbers here and I'll take a look?

What protocol are you following?

Without seeing the ss I can't comment on dose, but from your post in Relaxed I gather you're hoping to slow down diving early in the cycle. Generally speaking, sometimes it helps to spread out the meals in the early part of the cycle. Some cats do well with the food divided into 3 or 4 mini meals. For example if you usually feed 200grams in the day cycle and 200 in the pm cycle, (I'm just throwing out numbers as an example) try dividing it by giving 50 each at pre shot, +1,+2,+3 or +4.

Again, I can't see his current ss so I'm just speaking generally.

I gathered from Mel's comments that you don't live with him, is that right? Can you take him with you where you are?

You should probably be checking him daily for ketones. Does he have any history of them?

 

[Wendy&Neko]

Hi Di, I know that since Misho doesn't live with you, you are limited in the number of times you can visit him. Looking at his SS, it seems that sometimes his onset is at +3. I wonder if it would be possible to change his +4 snack to a +3 snack instead for a while and see what that does. The other option to try to reduce the big drops is to feed a slightly higher carb food. We've had some members switch from a 3-4% carb food to a 8-9% carb food. That allows them to get a little more insulin in to get rid of the highs and the little bit of extra carbs slows down the fast drops. I think a lot of the bouncing Misho is doing is due to his fast drops.

I also don't see why you dropped his dose down so much. He earned a reduction to 1.75U by going to 40 on December 1st, but I haven't seen any below 50 numbers below that. Or are you using the SLGS cutoff of 90 for reductions? The depot from a larger dose can impact up to 4-6 cycles after a reduction. When Misho got the 77 on the 5th, he could still be feeling the impact of the 2.0U from 4 cycles before hand. If you were following the TR protocol reduction point of 50, I think his dose should be 1.75U.

@Julie - European convention is day.month.year. I can see the SS fine.

 

[julie & punkin (ga)]

Maybe it's cuz I'm looking on my phone. I've reopened it 3 times and can only get August. I recognize the dates, lol. I'm glad you can see it and help.

 

[Di&Misho]

Hi everyone! Thank you to all of you who commented here. As it is 09:30 a.m. now here I can't stay and post in the forum but I promise to answer all your questions later .
Just a short answer to the question why I reducedto 1.25U - I thought that with less insulin he won't have these steep drops that cause the high bounce. This is the reason why I did so. I didn't know if it is right but was the only thing that came up to my mind.
THANK YOU! Will get back to this thread in about 3 hours .

 

[Di&Misho]

Hi everyone again. I will try to answer all questions in brief .
Sandy to begin with yours: Misho is fine no problem at all with him. I have seen him with numbers in HI (though long time ago) I have seen him in green 27 and if I haven't tested him I wouldn't know. He has no present health issues or at least not known, I can't test for ketones as he doesn't live with me but I used to test him in the very beginning and he never showed any which was very strange as he was in his 500's and over.
Insulin expiry date February 2015 .The current cartridge opened on September 4th. Glucometer calibrated I check with the control solution from time to time and I always recheck with my other glucometer Accu Chek Performa in case I doubt the result. Test strips delivered from UK - expiry date March 2015 .
Misho was previously on Integra Protect Diabetic - 7,4% calories from carb I switched him on Granatapet Veal and Rabbit flavor - 1,6% from carb. His daily allowance is 233 grams but I feed him 20% extra as he is underweight . His feeding schedule is consistent -now I feed him 4 times a day equal meals at insulin shot and @+4 when I test. I also have tried to feed him mini meals though it is very difficult for me as he doesn't live at home. If I could I would take him long time ago but it is not possible. I live in small apartment with my own pets 2 big dogs and 3 cats and one of them is definitely jealous and will have issues with Misho.

Julie - if you browse his ss on your PC you will see it. Other members also have problems on cell phones. We follow more or less the SLGS protocol but as Nadine said MIsho doesn't like rules I can't feed Misho those mini meals as you suggest, it is not possible for me under the present circumstances :cry: We actually follow ANY protocol since August 21st when I found THE FDMB. Anything before this day was shooting in the dark and I am sorry I have wasted so much time but in my country people extremely rarely at all treat pets with Diabetes and vets here don't have much experience. Misho was put on a very high starting dose he even had 2 types of insulin in one day and dropped very often from Hi to under 30 ... But this is another story. I am happy I found this forum and since then I read a lot and I feel more comfortable.

Wendy- I can change the +4 to +3 test and feeding, this is something that won't be a problem for me. As regards the food I actually slowly switched Misho to Granatapet which is very low carb as I thought it is better not to speak it is much cheaper( though still expensive) than Integra Protect. So from mid October to mid November I fed him both till I fully switched him to Granatapet. Both I order from Germany as in Bulgaria you can only find dry Diabetic and Royal Canine wet which is very expensive. In the very beginning I also could buy Integra wet buy after my second order the importer said they don't have quantities available :lol: So i decided to directly order the food from Germany as you never know when you will be surprised again with such answer. If Integra will be better for him(being higher in carb) I can mix 50/50 for example but for the moment I don't have available it usually takes 10 days to be delivered to Bulgaria.
As regards reductions - The only reason why I did this was to slow down his steep drops as I don't find it normal if he drops to blue numbers and they sky rockets to red and blacks every day. The idea was to flatten him if possible. I don't say it was the right decision to make but I did it. If you think it was a mistake and I have to go back to 1,75 or 1.5 I will. By the way forgot to mention that MIsho has always failed reductions though he earned them several times and this is the first time when I reduce his dose and he is not in pinkies and reds only

Well, I think I answered all questions. Too much writing but I cannot answer in one word only. Today @+4 Misho was 416 . And Nadine you are right ,I am so worried lately that I don't think rationally

If the written above gives you more clear idea of the situation and you have advise for us will be happy to read it. All folks from Relaxed Lantus has always been very helpful to us but more points of view are always welcome. What I want to avoid are those steep drops and bounces at the end of the cycle to reds and blacks only as I don't find this normal Thank you to all of you in advance!
I do apologize for any spelling mistakes , I have no time to spell check now!