Much better AMPS this morning

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Bron and Sheba (GA)

Bron and Sheba (GA)

Member Since 2015
My name is Bron and my cats name is Sheba. I posted over on the introduction page on 21 Feb. Sheba has been diabetic since April 2011. She went into remission after 3 months but fell out of remission in Nov 2013. She is on levemir 6.25 units. She is a very bouncy cat. Eats well. I have had a hard time regulating her. She was doing really well late last year and earlier this year (not regulated but getting there) but things have fallen apart a bit. She gets pain from arthritis which effects her BSLs and this has been an issue in the last 2 months and is probably the reason she has worse numbers. She is having the pain issue addressed at the moment and is on medication again which I think is helping.
Marje has been a tremendous help getting Sheba's SS up and running. Thank you Marje.
I have filled in most of this years numbers although I left out a couple of weeks in January as they were much the same as the others.
Sheba used to bounce with low or what she thought were low numbers but she seems to be used to those now and now she likes to bounce if she drops too fast which she does a lot. Wendy and Neko suggested I feed some higher carbs to try and stop the fast drop. I have been doing this and it seems to help a bit but has not stopped the bounce completely. I have been trying to get some early numbers to try and catch her before she drops fast but I am not always successful.
If you are able to help Sheba or make suggestions I would be very grateful. Thank you so much.
Bron
 
How did yo arrive at such a high dose? Your SS starts at 5 1/4 units.
Some of the BG show a flat or increase in BG after the shot. That typically indicates the does is too high or the insulin has lost its effectiveness. How old in the insulin?
 
Had you considered feeding mini-meals? This is where you divide each primary feeding into 2 or 3 smaller meals and then feed at pre-shot plus +3 or pre-shot plus +3 and +5, (examples - you have to figure out what works for you). Any of those mini-meals could be slightly higher carb to additionally slow the drop.


 
Larry and Kitties said:
How did yo arrive at such a high dose? Your SS starts at 5 1/4 units.
Some of the BG show a flat or increase in BG after the shot. That typically indicates the does is too high or the insulin has lost its effectiveness. How old in the insulin?
Click to expand...
Hi Larry,
Sheba has been on insulin since Nov 2013. She started on 1 unit. She was on a higher dose almost a year ago but dropped in dose after she started pain medication for her arthritis. Not recently, but earlier on, I tried reducing the dose of insulin and it did not seem to solve the problem, she just went to the Litter box more.
I go up in one quarter unit doses if I increase.
The insulin is only new. Thank you, Bron
 
BJM said:
Had you considered feeding mini-meals? This is where you divide each primary feeding into 2 or 3 smaller meals and then feed at pre-shot plus +3 or pre-shot plus +3 and +5, (examples - you have to figure out what works for you). Any of those mini-meals could be slightly higher carb to additionally slow the drop.
Click to expand...
Hi BJM,
At the moment I feed Sheba at preshot and at +3. I only give her small amounts at a time otherwise she just bolts down the lot and then she vomits it back. She loves her food. If you think giving another mini-meal at + 5 will help I will try it.
Thanks Bron
 
For scarfers, spread the food thinly across a wide plate; it helps slow the cat's eating.
Adding a tablespoon or two of water provides additional volume, too.

You could try feeding a bit more at the meal before the big drop and see how that works, since you are splitting the meals already. That way it won't be as big of a change in schedule (less confusing for me, anyway!)
 
BJM said:
For scarfers, spread the food thinly across a wide plate; it helps slow the cat's eating.
Adding a tablespoon or two of water provides additional volume, too.

You could try feeding a bit more at the meal before the big drop and see how that works, since you are splitting the meals already. That way it won't be as big of a change in
schedule (less confusing for me, anyway!)
Click to expand...
BJM,
I tried giving some food at +5 today as you suggested. I already add water to her food but have not tried spreading the food around the plate. Thanks for the suggestions. I will try giving more food before the big drop and see if that helps. I think today her numbers were more sedate. She looked like she was coming off a bounce to me as she just went down to PMPS. But I am no expert. What do you think?

Tonight 15 mins before PMPS I took Sheba's BSL and it was 9.7 (174) and when I took it at PMPS it was 8.7 (156). I waited for another 15 mins and took it again and it was 10.1(181) so I gave the insulin. Did I do the right thing? I did not feel comfortable giving insulin to a falling number.
Also I do not know how to record this on the SS. How do you record a BSL if it is say for example + 4.5 hours and not on the hour as per the SS chart?
Also can you change the heading of your thread or do you have to start a new thread to do that?
Thank you, Bron
 
Bron and Sheba said:
Also can you change the heading of your thread or do you have to start a new thread to do that?
Click to expand...
Hi Bron,

You can edit the title of your thread.
If you look at the top right hand side of your first post you'll see 'thread tools'. If you click on that you'll get the option to edit the title.

You were right not to give insulin on a falling number.
Was that 10.1 a 'natural' rise or did Sheba have any food that might have influenced it?
How is Sheba doing now?

Eliz
 
Hi Eliz,
Thanks for the information on how to change the title of the thread.

No, the 10.1 was a natural rise. I tested her a bit earlier than usual and if it had been a bit higher I probably would have just given her the insulin 15 mins later but because it was a low PMPS - for her - I thought I would test again just to check she was not dropping. When she does have a low preshot number like that, she often drops lower before rising.
At + 3 she had risen to 18.3 . It could be a food spike as she always rises several points after eating if she is on a low number at preshot. But she may just be on the rise. I am just off to bed but will get up in a few hours just to check where she is at. If it is just a food spike, she drops back quickly to the preshot number once the insulin kicks in.
Thanks for your help Eliz.
Bron
 
See my signature link Glucometer Notes for some info on the accuracy of retail glucometers ... as in, they read within 20% of what a lab would get.
so
50 -> 40 to 60, a range of 20 mg/dL
500 -> 400 to 600, a range of 200 mg/dL

If 1.2 * lower number is greater than 0.8 * higher number, the 2 numbers actually could be equal.
So lets check:
lower # vs higher #
8.7 (156) vs 9.7 (174)

calculation results:
1.2 * lower vs 0.8 * higher
10.44 (187.92) > 7.76 (139), so these numbers could be about the same.
 
BJM said:
See my signature link Glucometer Notes for some info on the accuracy of retail glucometers ... as in, they read within 20% of what a lab would get.
so
50 -> 40 to 60, a range of 20 mg/dL
500 -> 400 to 600, a range of 200 mg/dL

If 1.2 * lower number is greater than 0.8 * higher number, the 2 numbers actually could be equal.
So lets check:
lower # vs higher #
8.7 (156) vs 9.7 (174)

calculation results:
1.2 * lower vs 0.8 * higher
10.44 (187.92) > 7.76 (139), so these numbers could be about the same.
Click to expand...
Hi BJM,
Thanks for the explanation and information on the accuracy of glucometers.
It is a bit scary really when one is trying to decide if a number is a falling number or not; or in the case of a very low BSL, if the number is rising or if it is just the 20% variance.
This morning Sheba was high again but had dropped 5 points (mmol/l) at + 2 and usually her insulin doesn't kick in until closer to +3 so I gave her a tiny amount of medium carb. I hope that was the right thing to do. She is not too happy with me spacing her food out and is at my feet constantly asking for her food! But I am happy to do it if that can get her sorted:cat:
Thanks
Bron
 
Critter Mom said:
Hi Bron,

How did Sheba get on?
.
Click to expand...
Hi Aine,
Sheba decided to go up last night after giving me a lovely preshot and had a high AMPS this morning.
It is so depressing- I try so hard to get her regulated. She comes down into good numbers for me but most times goes back up high. A couple of months ago she was responding to nearly all the doses of insulin and giving me good or reasonable cycles but she would still go high for a lot of the AMPS.

I have tried feeding her during the night in case it is the dawn phenomenon but there is no difference. Her numbers got worse when the effects of the metacam wore off when I stopped it, but I have restarted it at a small dose (my vets suggestion and I am OK with it) until the effects of the cartrophen injections are known. She is in the middle of a course at the moment of caltrophen. She is definitely happier on the metacam and her mobility is better and she will go up and down the stairs a lot more and much faster. Her numbers are better on it as well so I am hoping they will continue to improve once it calms her arthritis down again. I know people in the US do not like metacam but we have a cat specific dose out here and my vet is monitoring her closely. I am thinking of quality of life too. There is such a difference when she is on it and I know myself the relief I get when I take a voltaren for back pain.

Can you tell me how to document a +11.5 or a similar number in the SS please. One that is not a +3 or +6 number for example. I tried to document the 9.7 and the 8.7 last night and it would not let me. Thanks .
I hope you and Saoirse are having a good day.:cat:
Bron
 
You can manually enter the numbers multiplied by 18 to get mg/dL within the US cell, separate each by commas, and color code as desired.
On a Windows machine and many smart phoes, there is a calculator you can use to get the numbers you need. You'll need to remember the number briefly as it likely won't copy and paste.
 
This confirms it.....I am dumb! It lets me write in the numbers, but when I look on the SS of the forum it just has value# written where I put the numbers. :arghh:
I am using the world SS and Marje said only to record on that SS.
 
Hi Bron,

It does sound like the stress from the pain is feeding into Sheba's numbers. Poor little thing. :( I'm glad that you are able to make her feel more comfortable. As you astutely observe, quality of life is key.

I'm in the same situation as yourself with the feeding. It makes me sad not to be able to give Saoirse a really satisfying meal at the moment. I wish I could find a reliable food source for her that would be satisfying, keep her numbers in the healthy range, not upset her tummy, and be consistently reliable in quality. The pancreatitis and possible IBD do make things harder. (sigh)

Re the spreadsheet question, for single readings I just put them into the cell for that hour. If I needed to record more than one reading in a cell, I'd type both numbers in (press ALT-Return to insert a carriage return between them) and then manually colour the cell using the Fill function (usually matching the cell colour to the lower reading). You could then put a comment in the Remarks section about the timings of the 2 readings. Altermatively you could annotate the cell itself by right clicking on the cell and selecting the "Insert Note" function from the drop down list. Here's a link to Saoirse's 2015 spreadsheet. You can see how the note function works from that (I use it to record feeding information).

https://docs.google.com/spreadsheet/ccc?key=0AizC7e2GcQiqdGRxU25VRUl4b1hhbzNLeG01a1ZNTFE&pli=1#gid=5

You should carry on entering the numbers in your World mmol sheet, but you'll also need to manually enter the mg/dL numbers (mmol values x 18) into the spreadsheet with the US tab. The #VALUE is most likely an error message in the US spreadsheet due to the formula in the affected cells trying to multiply a text value (the numbers you manually entered in the World mmol sheet cells) by 18 to give the US equivalent BG values. (Does not compute! :rolleyes:)

If all of that sounds like far too much frelling around, you could choose to put the most significant value in the BG column in the mmol sheet and just put the additional readings and times in the Remarks column. That way, the US mg/dL cell will calculate as normal. I'm not sure whether the US sheet automatically copies comments from the mmol sheet. (My spreadsheet's a custom jobbie so I set up the formulae myself to do that - can't remember whether the standard templates do it.)
 
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Bron and Sheba said:
This confirms it.....I am dumb! It lets me write in the numbers, but when I look on the SS of the forum it just has value# written where I put the numbers. :arghh:
I am using the world SS and Marje said only to record on that SS.
Click to expand...

There is an exception to that rule - not when you have multiple entries in 1 cell. Then you must calculate the mg/dL by multiplying each glucose test by 18, and manually entering each into the same cell, as I described above. When it is just 1 entry, there is a formula which does the math for you.
 
OK thanks BJM. I will do that. Thank you very much. I have several grandchildren here at the moment so will have to wait until they go home so I can concentrate. Everyone is so patient and helpful on the forum.
Bron
 
Hi Aine,
I have just looked at Saoirse's profile and SS. Lots of lovely green and then OTJ - lucky you. And that is a beautiful photo of Saoirse. She is a sweety.
Sheba was OTJ for a couple of years before a prolonged dose of chronic diarrhoea tipped her out of remission. For months I struggled to find the cause of the diarrhoea and managed to control it with cooked pumpkin I cooked every few weeks and froze in useable lots. Finally I stopped the M/D and the diarrhoea stopped. After trying a few canned foods, I switched to home cooked chicken and raw kangaroo meat and she has been so much better. She put on weight and her coat improved and she loves it.
Thanks for the info on the SS and the numbers and how to put in the odd numbers. My computer is slow and infuriating. I mostly use the IPad but use the computer for the SS. I think I am too tired to look at it tonight. I make mistakes when I am tired. I might do it tomorrow when I feel refreshed.
Bron
 
Hi Bron,

Saoirse is a sweety alright. I'm glad you like her photo. As I said to you before, I really love the photo of Sheba in your avatar. Her expression is so lovely, and she makes me smile every time I see her (and I don't do enough of that these days). :)

After Saoirse's pancreatitis flare, I worry all the time about diarrhoea now. I'm struggling to find a food for her that keeps her numbers in the normal range and that doesn't upset her tummy (hence all the annotations about meals in her spreadsheet). I was encouraged to hear about the success you had after finding foods that agree with Sheba. Saoirse is booked in next week for a dental, an ultrasound and also a blood draw for allergy testing. I'm hoping the allergy tests will give me a signpost as to how I might be able to feed her without causing her discomfort. It withers me to see her crouching or hiding after many of her meals. :( At the moment, the food I'm giving Saoirse seems to be constipating her. I'm trialling a trace of pumpkin in her meals at the moment to see if that will help her.

I'm glad you found the spreadsheet info helpful. Just give a shout if there's anything else you need help with. :)
 
A lovely surprise for me this morning with Sheba's AMPS 13.8 (248) after a week of high AMPS. She has also had low PMPS for the last 2 days so I am very happy. Fingers crossed it lasts. She had a big food spike after PMPS last night and I thought she was on the way up but when I got up to test her, she was dropping again:cat:

Aine, I am so sorry Saoire has all those tummy issues. It must be hard watching her hide with a tummy ache. Maxie, my other cat who died 2 years ago, had IBD or similar issues and I was always looking for food that would not affect him adversely. He had bloody poops at times as well which didn't seem to worry him but I hated seeing them. I never thought to feed him raw but I am sure if I had, it would have helped a lot (after seeing how much better Shebas bowels are). But I can see you have to be super cautious with Saoire because of the pancreatitis. You don't want to waken that giant! I have found cooked plain pumpkin good for diarrhoea and constipation. I still give half a teaspoon twice a day to Sheba as roughage in her raw diet and generally her poops are just right (anti jinx).

Thanks to everyone who is helping me- it looks like things could be moving in the right direction:)
 
I'm sorry to hear about Maxie, Bron. :(

I'm nervously waiting for the first round of pumpkin poops at the moment. It's really helpful to hear that it helps Sheba, and also to hear how much you give her. Saoirse really likes the pumpkin but I'm introducing it very slowly. Her tummy doesn't seem to be quite as distended today, but it's hard to judge. Changing anything scares the bejaybers out of me. :nailbiting:

I'm really pleased that Sheba's numbers are improving. Fingers and paws crossed in the Shire that the improvements will continue. :)
 
Hi again Bron. I think that the Levemir is working fine for Sheba. Since she's on a bit of a higher dose, it's one of the better insulins for her. Lantus can sting some cats at higher doses so the majority of the higher dose cats will switch. It does depend on the cat, Neko got to 8.75U on Lantus and it didn't seem to bother her, but she's gotten better numbers on Levemir. One of the fun things about Levemir is that often kitties will have their nadir at preshot. Neko's low point is usually between +9 and +12. That means that I'm shooting a dropping number a lot. I know that I've got about 5 hours after her shot until her onset, so plenty of time to feed her and get her up.

You might want to think about popping over to the Lantus and Levemir forum. We have a couple of methods people there used for determining doses, the Tight Regulation Protocol and the Start Low, Go Slow Method. If you pick one of those, people can help you with dose decisions.
 
Hi Sarah,
It's good to be back thanks. Yes I have been using Wendy and Neko's suggestion about feeding a higher carb early to slow the drop and BJM's suggestion to spread the feeds a bit. Something is helping as Sheba's numbers have been much better the last couple of days.
I started with glargine ( lantus) but swapped to levemir about 6 months ago. She is somehow happier on the levemir, I can't explain why, but she is.
Pain from her arthritis plays a large part in her BSLs and when she is not on pain meds her numbers go up.
She has been much more her old self the last few days, I hope it continues.
Thanks for inquiring. I hope all is well with you and Remi. I remember you saying Remi's blood tests always show an inflammatory response to something. Sheba had blood tests last week and her inflammatory response number was very high as well. The vet thought it could be the diabetes or the arthritis. What does your vet think it is from?
Bron
 
Hi Wendy and Neko,

Sheba has been having much better numbers the last couple of days. I have been trying to get a test early on each cycle to see if she is dropping fast and when she is I am giving her a small amount of medium carb to slow the drop. I am sure this is helping with her improved numbers. I am also spreading the feeds out a bit as suggested by BJM. Sheba is also starting to have some lower preshot numbers which make me very happy. :) And I think her cycles have been more sedate instead of a race to the bottom (well that is how it felt!)
I have noticed when she has a low preshot number, she has a noticeable food spike, but if she is going to have an active cycle, she drops back down fairly quickly about +4 to around the preshot number.
That is interesting Neko's nadir is between +9 and + 12. Up until now Sheba's nadir has been usually around+7 or + 8 and then up she would go - and I often thought she had a short cycle, especially if she dropped quickly. But the last few days with the more controlled drop, she has had a later nadir.
Yes I would be very happy to go over to the Lantus and Levemir Forum. I will post there tomorrow morning. Thank you for mentioning it. For the first time I feel there is some hope I may get her regulated. Of course I would love remission again but for now I would settle for regulation. You help has made a difference.
Bron
 
Hi Bron

Remi has a number of inflammatory conditions that the vet says could be showing up in the test results, namely asthma, IBD and pancreatitis (triaditis). I am lucky that this didn't prevent remi becoming regulated and then off the juice.

Before he was diabetic remi did have a bad pancreatitis flair that ended up with his blood glucose levels rising but this came done once the flair receded.

Please do post over on the lantus and levemir forum. You will get lots of advice.
 
Hi Bron,

I'm so pleased that Sheba is doing better and that you are happier, too.

I can't cope with the activity on the L&L board (utterly overwhelms me and makes me feel more panicky) so I won't be able to follow Sheba's progress there, but I do wish you both the very best. I'll be sure to keep an eye out for anything you might post on Feline Health.

:bighug: for you and scritches for your beautiful girl.
.
 
Bron and Sheba said:
I started with glargine ( lantus) but swapped to levemir about 6 months ago. She is somehow happier on the levemir, I can't explain why, but she is.
Click to expand...
We had a number of people who switched from Lantus to Levemir make the same comment.

Awesome cycle last night!
 
phlika29 said:
Hi Bron

Remi has a number of inflammatory conditions that the vet says could be showing up in the test results, namely asthma, IBD and pancreatitis (triaditis). I am lucky that this didn't prevent remi becoming regulated and then off the juice.

Before he was diabetic remi did have a bad pancreatitis flair that ended up with his blood glucose levels rising but this came done once the flair receded
Hi Sarah,
You were certainly lucky to get Remi OTJ with the pancreatitis. Sheba gets flares occasionally and they come out of nowhere. I hope I am as lucky as you with the OTJ. While Sheba was in remission she had a few small flares of pancreatitis and her BSL went up as well but came down as soon as she improved.
I have posted over on the L/L forum so won't post here again after I answer the above posts. Thanks for all your support.
Bron
Click to expand...
 
Critter Mom said:
Hi Bron,

I'm so pleased that Sheba is doing better and that you are happier, too.

I can't cope with the activity on the L&L board (utterly overwhelms me and makes me feel more panicky) so I won't be able to follow Sheba's progress there, but I do wish you both the very best. I'll be sure to keep an eye out for anything you might post on Feline Health.

:bighug: for you and scritches for your beautiful girl.
.
Click to expand...

Thanks Aine,
I am sorry I won't see you in L/L but hopefully we can keep in touch. You have been a great support to me and I really appreciate it.
I hope the pumpkin is working its magic. The first time I used it Sheba had very loose poops. Within 3 hours she had produced a formed poop. It was such a relief to see it after months of loose poops. My vet had never heard of it before. It seems to work just as well for constipation. Sheba is quite happy to eat it as well which helps.
Please give your beautiful Saoirse a big cuddle from me and here's one for you :bighug:
Please pm me how Saoirse is going on the pumpkin. Fingers crossed it works as well for her as it did for Sheba.
Bron
 
Hello Bron,we are in the UK and my boy Bailey has arthritis,Adequan is not licensed here so my vet is looking into using Cartrophen but he is not sure if it will raise Baileys bg levels,has it raised Shebas b/glucose ?and are you seeing any improvement? Diane
 
I'd like that very much, Bron. I'm so glad that I was able to help you a little bit. :)

Thank you so much for the 'what might happen next' info re the pumpkin. Still waiting for poop here, but there have been times when I think my Saoirse's tum hasn't been quite as distended. I have also had one or two better BG numbers since I started her on it. As with Sheba, Saoirse happily eats it. (She'll lick it off my finger with great gusto!)

Cuddle delivered to my little Munchkin (and thank you for my one, too!). Sending scritches for Sheba and :bighug: for you. I'll be sure to PM you with ourp pumpkin progress.
 
BaileyUK said:
Hello Bron,we are in the UK and my boy Bailey has arthritis,Adequan is not licensed here so my vet is looking into using Cartrophen but he is not sure if it will raise Baileys bg levels,has it raised Shebas b/glucose ?and are you seeing any improvement? Diane
Click to expand...
Hi Diane,
Sheba has had 2 cartrophen injections so far and the next one is due tomorrow (weekly for a month). It has not affected her BSLs adversely. In fact she has started to have lower numbers. My vet has only given it to one other cat but lots of dogs. He said that the cartrophen he was using was 'the next generation' of it and was better than it was before.

It is hard to judge if it is doing any good as the vet has put Sheba back on a small dose of metacam until the cartrophen kicks in. I know the U.S. people do not like metacam however we have cat specific metacam for cats here in AUS. My vet is very cautious with the dose and I am fine with that and it makes such a big difference to Sheba's quality of life.
I definitely think giving the cartrophen injections is worth trying for your Bailey. Good luck with it.
Bron
 
Hello Bron,many thanks for replying,the information is really useful,my vet asked if I had any feedback from the forum as he has only prescribed it for dogs,I pass on your findings.
 
Maybe monitor for dehydration, water consumption, and urine output, since you're using the Metacam. That'll give you a heads up if anything changes drastically. See my signature link Secondary Monitoring Tools for some tips, plus other assessments you may find helpful.
 
Hi BJM,
Shall look at your secondary monitoring tools thanks for tips. So much wonderful information here on the forum.
I give Sheba extra fluids every day and record them so I know how much she has had. Also record urine output. I check her mouth for level of moisture most mornings before she eats, and if her BSLs are high I try and give more fluids. She loves the broth I make (chicken bones and water, nothing else) so it is easy to give extra. She thinks it is a treat.

When she was first back on insulin this time and her BSLs were really high, she used to get very lethargic. At the time I didn't recognise she was dehydrated because I had never had a cat like that before. It was only after she had had subQ fluids a couple of times I realised it was just dehydration causing the lethargy. I had thought she was actually sick with something. So now I make sure she drinks plenty.
Thanks, Bron
 
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