Mittens 9-27-13 AMPS 387

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Lyndsey & Mittens

Lyndsey & Mittens

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Mittens AMPS=387, increased AM dose to 1.25u. Prob should have increased to 1.5 since I will be home all day to monitor...didn't think of that until after I shot ohmygod_smile

He seems to be less sensitive to the insulin as he was during the first few weeks he started out on it, is this normal in some cats? When he first started out, he'd barely just have to look at the insulin bottle & his BG would start dropping...
 
I'll do one today-took the day off work so I can get more mid-cycle tests in-and some rest too (I have insomnia & after waking up in the middle of the night to test the cat it has been proven impossible for me to fall back asleep)!
 
I think the increase was a good idea. And as far as yesterday's conversation about inverse curves... I don't see yesterday as inverse. It is "flat" to me. In order for me to think of it as inverse, the shape of the "frown" needs to be really obvious, like 100 points or more when you're dealing with pink or red numbers.

Like Lisa said yesterday....if they are just a once-in-a-while thing, no big deal. When/if you see them happening regularly, then they might mean something. I don't see them as a pattern here.

To answer your question, yes a cat can become less sensitive as time goes on. The higher numbers can lead to insulin resistance if they go on for prolonged periods of time. That's why I tend to side with a pretty aggressive approach to dosing (and why I bumped up the starred thread about glucose toxicity). I'm not saying that's what's going on with Mittens, but I'd be much happier to see some blue and green numbers on your spreadsheet. ;-)
 
Oh forgot to mention....
Sometimes the curves and numbers have as much to do with food as with insulin. I meant to ask what is Mitten's normal food routine as far as when he eats during the day or night?
 
I wholeheartedly agree with Carl. Treating the hyperglycemia is key to managing diabetes and its horrible effects on every organ system. I know that hypo can kill quickly, but hyper is doing damage every minute the BG is above normal. To baby those Islets, we have to strive for BG's in the normal range. Thanks, Carl, for those glucose tox articles. Cats are very similar to humans with Type II. I am aggressive with the insulin, because I want those greens.
Good Luck Mittens! I hope you can go green soon!
Thank you all! I am new to cat diabetes and have learned so much from all of you!
Arlene
 
Re: Mittens 9-27-13 AMPS 387, +4=261, +6=362

Ok-I've got some more data-after the yellow at +4, I was sure I'd get a decent number at +6-not the case :YMSIGH:
+4=261
+6=362

As far as his feeding goes-he gets 1 can LC FF with his AM & PM shots, and about a half can during mid/late-afternoon (which he rarely eats-he'll wait until I get home from work) & a half can during the middle of the night. He also will get about 1/3 of a can before I go to bed for the night (if he ate all if his dinner). He's a big guy-almost 17lbs...

I always make sure food is up 2 hours prior to shot time.
 
Okay thanks for the food timing schedule :-D

Feeding at night is a good way to allow you to sleep without worrying about a late night low. When I look at a spreadsheet, it helps to know when food is on board, because I'd expect to see a "boost" and hour or so after eating.

For instance, if not much in the way of a drop happens around +4, and then a kitty eats around +6, or just before then, I would expect to see a rise in the middle of a cycle. That makes logical sense. But it can also be misread as an "inverse curve". If the dose is too low, the cycle will be flat, and the "bump" in the middle could be due to food, not to too much insulin. Make sense?

There are really only two factors that we as caregivers can control. How much insulin we give, and food timing/amounts. That's what we add to the equation. There isn't much we can really control once both things are added to the cat's body. So I always look at food and timing of meals as an important factor when I try to make sense out of a spreadsheet.
 
Yes-makes sense, thanks Carl! For the +6 I got today, I held off on feeding him his afternoon "snack" until after I had got the reading as I didn't want it to be food influenced. So, as far as the increase at the +6 (i was def expecting a decrease in bg) what are your thoughts?

I'll be doing a +8 in about an hour...
 
So, as far as the increase at the +6 (i was def expecting a decrease in bg) what are your thoughts?
Click to expand...

Well, I will just tell you the way I normally think...

I don't put a lot of weight on the whole "inverse curve" theory. Others do, and they have their reasons and logic. I've just never really agreed with the theory.

To me, when you see a frowny faced curve, if the high in the middle is due to too much insulin, then I guess I need to "see" the low number that caused the high number that follows. Usually, I can't see it. That doesn't mean it isn't there, just that nobody saw it on a meter. So at best, it's not supported by data. Having said that, I think two reasons exist for high numbers, no matter when they happen in the cycle

1- a "bounce" due to the numbers going low enough for the liver to panic and dump "sugar" into the bloodstream. And bounces can take a couple days to go away sometimes. Sometimes they go away more quickly. So I look for the "low" that caused the "high".
2 - not enough insulin. If you see a flat cycle, one that doesn't show a "dip" in the middle of the cycle, AND you don't believe the kitty is in the middle of a bounce, then it's probably due to the prior dose being too small.

The cycle in particular on your spreadsheet that confuses me, that I can't explain, is the PM cycle on the night of the 20th. The one that gave you a beautiful but not shootable 48 the next morning. On that one cycle, it looks like Mittens responded great to 1.0u, and just kept dropping longer than logic would say he should have. I can't explain why that happened. It just did. The previous cycle, that morning, the same dose seemed to do nothing for him.

Then I think on the morning of the 22nd, two things caused that red preshot number. And you noted both on the comments on the SS. 2 skipped shots AND a bounce from that 48. You may have been able to shoot a small dose on the 176 PMPS the evening of the 21st, because the number was definitely a rising number. I understand why you may not have done that....he was under 200, and that's the "line in the sand" we usually draw as far as not shooting.

That AM cycle to me, looks like the bounce decided to not stick around for long. It wasn't that the AM dose of .75 was too much. It was that dose combined with the bounce clearing that resulted in the yellow PMPS of 286. But I think that the .25u shot he got at PMPS was too little. It didn't seem to cause a drop and let the numbers rise instead.

Getting back to today's higher number at +6.
It looks like the dose just didn't last long enough. It obviously did something, as his BG dropped over 100 points in four hours. It just seems to have petered out earlier than it should have. Sort of the opposite of what happened with the shot the night of the 20th, the one that seemed to last forever. It don't think the rise since +4 is "bounce" because I don't see a number that might have been low enough to cause him to bounce. Just for whatever reason, the dose wore off early.
 
Re: Mittens 9-27-13 AMPS 387, PMPS=402

Interesting Carl, thanks for your perspective!

Mittens BG at shot time was 402 (no distinct downward curve at the end), so for whatever reason it looks like (I think?) that the AM shot did wear off early. I'll keep an eye on that to see if that continues to happen.

I stuck with the 1.25 for tonight, but if no difference is seen ill up the dosage again (1.5u) tomorrow. Is that too soon to increase the dose? I know you should wait a few cycles before upping the dose, but I really need to get his BG down...
 
Hi Lindsey,
"Holding the dose" is another area where I tend to think differently from other people. (I think differently a lot, I guess :-D )

The usual line on Prozinc is that is a "one and done" kind of insulin. In other words, you shoot, it does it's thing, and then it wears off and is "gone from the system". I agree on that for sure. In most cats, it lasts 12 hours, sometimes a little less, or a little more, but once it is done, it's gone.

Given that, my thinking is that when you shoot a dose, any dose, you're likely to see the results of that dose within the next 12 hours. Unless something else is also influencing the numbers that cycle - like a bounce for example - then my belief is "what you see is what you get". So I don't really think, (again, this is just my opinion based on what I saw with my cat) that "settling into a dose" is much of an issue with Prozinc/PZI. That's the primary reason I'm a fan of adjusting the dose on a daily, or even a cycle by cycle, basis.

Others have seen different results with their cats. Some people advise picking a dose, sticking with it for a few cycles or days, and collecting data to look at how a set dose does over a period of time. I don't usually advise that way. I'm big on "experimenting" and looking at preshots and nadirs and picking a dose based on those numbers.
 
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