Need guidance on Pumbaa's weird numbers today.

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Pumbaa

Pumbaa

Member Since 2012
AMPS = 293 He received 1U
+2 = 328
+4 = 341
+7.5 = 437
PMPS = 342

I haven't dosed him yet for the night, and haven't fed him yet. Should I stay at 1 unit?

I know he didn't get into any carbs today to cause the numbers to go up like that. Mel mentioned an inverse curve and that it might indicate giving a lower dose, but he's still in the mid-300's.

I don't know what to do at this point.

I want to stay on schedule, and since Pumbaa was still at or above 293 all day, I am thinking that I need to stay at the 1.0 unit dose. If he was getting too much insulin, he would have had a much lower number than the 293 at his AMPS, right?

I'll test him a couple of times tonight to see how he's doing...
 
You know, maybe the high numbers are just a reaction to the yellow amps.
Even still, the numbers are looking OK to stay with the 1u.
Will you be able to test a bit tomorrow to see if you can reproduce the same sort of curve?
 
Gayle, yes, I am self-employed and work at home, so I will try and test Pumbaa as much as I can tomorrow to see if we get the same results. I was thinking that the high numbers might be a "bounce" to his 293 this morning, but, geez, I hope he doesn't bounce every time he gets a lower number.

I'm trying to wrap my brain around the insulin and the bounces and the numbers he is exhibiting. After I test him in the morning, AMPS, I might consider upping his dose by .5, just because he has never been dangerously low in his readings, and his body seems to be fighting the good numbers by dumping sugar into his system, which tells me that things are working. But I want him to be in the blue and yellow zones, regularly, instead of these magenta and red zones.

Does this sound logical to you?
 
The better numbers will come in time. First you get the odd yellow, and then later, you get a couple yellows, and you will find that each time Pumbaa goes lower, gets used to the better numbers.

Best of luck on whatever dose you do; it's great to be at home and be able to do testing at various times.
 
Yep sounds perfectly logical but that isn't the way it works...The way to think about it is...okay when fall first starts and after it has been in the 90s all summer long and you go outside the first morning it is in the 60s you go tearing back in for a jacket it because it is freezing outside...but by about March after you have frozen your hiney off all winter and you walk outside and it is again 60s you can't wait to get back inside and put on your shorts...right? So depending on what you are use to that smae 60s degrees can feel either good or bad. Well same thing for their numbers after they get use to being in those 400s and suddenly feel a 200 again that just feels way too low and they want to head in and get that jacket on so the liver dumps stored sugars to make that jacket. Once they start staying in those 200s again and get comfortable with that and they hit a 100 they bounce again.

Eventually the reds become more pinks then the pinks become yellows then the yellows blue and so on.

There is a reason we call it a dance, you both have to learn the steps to be able to dance gracefully together but they have one advantage over us, they can actually hear the music we are dancing too....The best we can do is follow their lead. And just like learning any new dance there will be times when you feel like you have two left feet, you will trip over yourself, you will be tempted to rush the tempo etc. But with time and patience pretty soon you will gracefully glide across that dancefloor in perfect sync. Then they decide that instead of doing a waltz today they will feel more like doing a salsa...lol

Mel, Maxwell, Musette & The Fur Gang
 
Just got a nice 294 +2 after the PM shot. I'm a logical person and there is no logic behind the readings I've been getting. *LOL* That is what is frustrating!

Did I do a fur shot this morning? If I did, why did his BG number go down right before his PMPS?

I am just very happy that I shaved his right flank, and may shave more areas so that I can vary where I give the insulin, and still have no worries about giving fur shots.

So I am happy, tonight, that at +2, his BG is down. 294 isn't great, but it's better than it has been today!

I need to test again before I head to bed for the night, to see how Pumbaa is doing. At this time, I am not worried about him going hypoglycemic. I won't worry about that until he is down in the blues, regularly, especially since I am not changing his dosage.
 
MommaOfMuse said:
Yep sounds perfectly logical but that isn't the way it works...
Click to expand...

Thank you, Mel!

Your dance analogy is perfect. I thought I was leading, with my care, but Pumbaa's body is the one leading, and I need to follow, yet also lead when I see that his body is out of step. Unfortunately, I want to lead, all the time, and never have my dance partner step on my foot. I am such a control freak! And I have to get over that, in order to deal with Pumbaa's health safely and sanely.

I just want my little guy to be in the healthy numbers, and am willing to do anything it takes to make this happen.
 
It will happen but it takes time, he didn't become a diabetic overnight, and he isn't going to be regulated or even in remission over night. Plus some cats waltz nice and easy into it and then there are cats like Musette that want to teach their beans to do a Quickstep, then a tango, then a foxtrot and then somedays she just seems to get stage fright and completely throw the dance card out the window...lol.

But we still dance, everyday is a different dance with different steps to even the familiar dances throw in to see if we are paying attention...lol. I so can relate to the frustration, when I adopted Maxwell he was textbook perfect on how it is suppose to work, he did everything he was suppose to, to go into remission...So I got cocky and thought I knew actually how to dance the Sugarcat dance...then came Musette and she taught me I didn't have a clue how she wanted to dance. First she taught me that Lantus doesn't work for every cat, she wanted Levemir. Then she taught me not to panick at low numbers that she would easily survive those with just a little low carb food. And most importantly she taught me not to focus on the numbers as much as the whole kitty...Is she happy, is she gaining/maintaining her weight, does she purr, play, preen etc. And that she doesn't need to spend the entire day in the double digits that as long as her preshots are in the 200s and she gets into the blues and greens around her nadir she is fine, she is just insulin dependent and that it is she who will decide if she stays that way or if she will get tired of shots and ear pokes and decide to do away with them in time.

And above all the rest listed above that the world would have been a little less bright today if 8 months ago a loving vet tech hadn't stepped in and called DCIN and staid her execution. And my family is so blessed to have our little fluffy Cupcake girl in our lives...insulin dependent or not. cat_pet_icon

Mel, Maxwell, Musette & The Fur Gang
 
Mel...I'm still laughing about Musette teaching you not to be cocky. *LOL* Musette is blessed to have you as her mom!

I can tell Pumbaa is feeling better today because he's sleeping on the ottoman in the living room, instead of under a table or behind a chair. That makes me very happy!
 
Just a note on home glucometer accuracy - the FDA allows them to be within 20% of the 'true' value

This means
test -> range in which true value falls
200 -> 160 - 240
300 -> 240 - 360
400 -> 320 - 480

In other words, if you have 2 test values, and the (low + 20%) is higher than the (high-20%), the test values may be considered the same.

And I probably would nudge the dose up 0.25 (which you have to eyeball) to 0.5 units (some syringes mark the half units)
 
BJM: Now my head hurts. *LOL* So the 437 could have been a 349, and the 293 could have been a 351.

Pumbaa is now on 1.0 units BID...so I should nudge that up to 1.25?
 
Sorry 'bout that! Its just important to understand that they aren't precision machines. They're good enough to give you a clue and use your judgement to manage. Also note that compared to a vet's lab equipment, which is calibrated for animals, at the low end, a human glucometer is roughly 30 points lower in its reading, so it will be different from the vet's numbers - don't panic at that, its normal. The Lantus protocol for tight regulation uses numbers based on human glucometers as well as pet-specific ones.

Although you don't have a full curve, I do think there is enough data there to support a cautious increase of 0.25 units (I always put in that zero, so you see where the decimal point is!). I'd do that when you'll be around and awake to observe for a bit. It isn't likely to have a drastic effect, but you never want to be nonchalent about insulin doses because things change - appetite, health, activity levels, etc. and that can affect the need for and use of insulin.
 
BJM: I totally agree with you about bumping Pumbaa up a tad. I'm going to keep testing him about every 3 hours today, and not do the bump until the morning dose when I can really watch how he reacts. And I like the "cautious" update of 0.25 instead of going up by half a unit. :)
 
Actually I'm not sure I would raise him just yet, first because his shed has just truly filled since he hasn't been on Lantus that long yet. Second because he did get down to blues on one pm cycle and then bounced to the reds, started clearing that bounce and then hit a lower than normal (for him) preshot and had an inverse curve which could either be from a second bounce or be showing too much insulin.

This early part of the dance is where it gets tricky until you have the data to know what their particular pattern is going to look like. There are a lot of factors that could account for the first part of yesterday. It could have been a fur shot although I doubt is since you didn't feel any wet fur or smell of insulin. Now that he is starting to feel better he could have eaten less than normal, a difference in carb count in the food, more active, and even I have found weather will effect Musette. I know after months of testing that when we have weather like we did the last couple of days she will run higher, when the barometic pressure drops her BGs go up. And during thunderstorms both Maxwell and hers jump significantly. I know with Maxwell it is fear, he lived through hurricane Katrina so when the winds howl and rain comes in torrents here he gets clingy and his BGs jump up. I just keep telling him its okay that he is safe and there has never been a hurricane in Nebraska. lol

If he was my boy I would hold the 1u for a few more cycles at least and let that recent bounce clear since you are getting some nice action today. You could have even had an air bubble you didn't see yesterday and given less insulin than you thought you did. But ultimately you hold the syringe and you have decide what you are comfortable with.

Mel, Maxwell, Musette & The Fur Gang
 
Mel: Good advice from you, too! While I hate seeing him in the 300's, you're right...he hasn't even been on the insulin one week yet, and his body is still adjusting to the 1 unit twice a day.

I'll see what his numbers look like the rest of today and tonight. And all advice is appreciated, that is for sure! Thank you!
 
Depending on the cat (always!), it can take between 5 - 7 days to stabilize on Lantus. And the protocol generally suggests waiting for it to stabilize somewhat before changing anything, because Lantus changes build gradually over time. Its really up to you - what do you feel comfortable doing? How much time do you have available to keep an eye on him.

Are you checking for ketones? That is another bit of info to help you decide how you wish to procede. Ketodiastix may be picked up from your pharmacy and dipped in fresh caught urine (with a ladel underneath the cat), held under the urinating cat (you may get showered), or dipped in fresh pooled urine (best if you put plastic over the litter). A temporary substitution of acquarium gravel can be used so that you can push aside the litter, tilt the pan, and dip into the urine. (Note: acquarium can be washed off, disinfected, dried, and re-used if you've the time and patience for it and money is an issue) Seeing ketones would likely prompt me to up the dose sooner rather than later. Not seeing them would reassure me if I wanted to wait.

This isn't a two-step Lindy, more of a slow dance, and Pumbaa is leading.
 
BJM: Pumbaa has been very good about letting me stick a flat spoon under his butt and catch urine mid-stream! I swear he pee's on command. All I have to do is take the privacy lid off the litter box, grab his spoon and him, put him down in the litter box, and away he goes!

I've been testing him about every two days and I actually made that a column (on the far right) on my spreadsheet.

He tested at about 5 (trace) yesterday and today, but was at zero two days before that.
 
I'd be a bit nervous seeing ketones,especially on reading about the treatments (hospitaliztion, IV fluids, 24 hour monitoring & testing) and related costs which can ocurr if the cat goes into ketoacidosis.

Extra fluid helps the body flush them; are you mixing some into the food? Folks here report adding as much as half a can worth, but I'd start with a tablespoon at first (sudden changes can provoke decline in appetitie)
 
BJM: Even before the diagnosis I always added water to their canned food, now I am adding even more. Yesterday I got Pumbaa to drink more water. I'm not too worried about the trace of ketones...yet. Especially since he's had some bounces. He had ketones in his urine when they tested him at the vet 2 weeks ago today, and we managed to bring that number down a lot. I'm going to have to go back and read some more, but I swore I had read that seeing a trace of ketones in a cat's urine isn't unusual.
 
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