Need help for Assam's Glu

[Cathy Chen]

Dear All,

Sorry, it's me again.

Recently the dose for Assam is from .5 back to .75, but the curve is getting unstable. Please see the form from 1/30~2/4.
https://docs.google.com/spreadsheet/ccc ... sp=sharing

The Glu goes back to over 200 everyday but the lowest can stay at 47. I have a hard time to figure the relationship between the dose and the Glu, so I really need some experiences.
Should I increase/decrease/maintain the dose? Is there something I didn't notice?

Assam is doing fine~She drinks as usual, and also eats same canned food. She takes antibiotic 2 pills a day from 1/29 night to 2/5 morning for her stomach issue. I just opened a new Lantus at 2/2 night. I am so confused and really need help...

Thank you for all your kindness.

Cathy

 

[Deb & Wink]

Hi Cathy and princess Assam!

I haven't commented on your posts before but I did go back and read through your previous posts and look at your SS.

I see a couple of things.

1. You said your were feeding Assam before you did the pre-shot test. You should be testing first and then feeding. Ideally, no food for 2 hours before those pre-shot tests. That is so we get a more accurate picture of what the BG (blood glucose) is, not one food influenced and higher because of the food.

2. You keep going back and forth between 0.5U and 0.75U. I think you might try shaving the dose, give a "Fat" 0.5U (same as a skinny 0.75U) dose. It's tough to measure, but just a tiny bit more than that 0.5U line on your syringe might make a difference for Assam.

3. Not taking those reductions soon enough. The TR protocol says a kitty on insulin less than one year, a newly diagnosed kitty that goes <50 mg/dL (2.77 mmoL) gets an immediate 0.25U reduction. You've been waiting too long to reduce the dose, using an older version of the protocol for kitties that have been on insulin more than a year or do not hold reductions well. TR is much more aggressive than the SLGS protocol you use over here in the Relaxed forum.

Reducing the dose:
•If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

Plus, someone mentioned patience pants, so here are a pair for you to borrow from my vast and never ending lending closet.


If you would add your SS to your user control panel, Profile tab, Edit signature, it would always be there for us to reference. You want to go into your google doc, under the File command, hit "Publish to the Web" and copy the link from the pop-up box that appears and put that link for published data into your signature. Think you could do that?

 

[hollyall]

I think Deb's advice to try and find a dose in between .5u and .75u might be just the ticket for Assam. I think when the kitty is on a small-ish dose a small change in the amount can make a big difference, at least that's what I've seen with my kitty who is currently on .5u.

 

[Cathy Chen]

Dear Deb and Hollyall,

Thank you for your advices. I really appreciate.

As Deb said, I did feed Assam before the pre-shot test to keep her not throwing up, but just like 5g canned food. I tested many times to make sure this 5g canned food won't influence her Glu. So I think it's not about the feeding issue.

For reducing, for example, when Assam had 47 on 2/3 +5, I should reduce the dose from .75 to .5 when I got next shot (which is 2/3 night). Am I right?

Sorry I am not a native speaker...

I already follow your lead to change the user control panel, please let me know if I did it wrong.

PS. The patience pants means I need to be more patience?

Thank you very much!

 

[MommaOfMuse]

All food is going to influence her glucose to some extent since her body turns everything into sugars to power her body. Some cats spike more than others on food. That's where blood sugar comes from. Ideally you want to test, feed, shoot all within minutes of each other. What I do with my two is I get everything ready to go. I test both set their food down and while they enjoy their breakfast or dinner I give them their insulin.

Its not normal for a cat to be throwing up on a regular basis. So that might be a separate health issue or can be a sign of her dropping to low.

Yes anytime you have a reading under 50 the next shot is given at the new reduced dose.

Mel and The Fur Gang

 

[Deb & Wink]

For reducing, for example, when Assam had 47 on 2/3 +5, I should reduce the dose from .75 to .5 when I got next shot (which is 2/3 night). Am I right?

Yes, you are correct. The reduction in dose is at the next shot time whenever your kitty goes under 50 mg/dL.

If you are strictly following the SLGS protocol, the reductions should be taken if your cat falls below 90 and the reductions should be 0.5U increments. I don't think that much of a reduction will work for Assam. I still think that trying for a "fat" 0.5U would be good to try.

You added the SS to your signature perfectly! Thank you so much for adding your SS to your signature. Now, we can view it whenever we need to, and be able to help you better.

 

[Cathy Chen]

Dear All,

Thank you so much for teaching me. I already try "fat" 0.5u yesterday night and this morning, The Glu didn't decrease very much during night but I will wait for 3-5 days. Hope I can see a pretty curve soon.

It's really hard to get "fat" 0.5u so I try to get 2/3u to see how it works. Assam is doing fine. She has chronic pancreatitis but it is in the control and starts getting well. I am still working on the throwing issue but I believe it's getting better now!

About the dose I still have a question. I know when a kitten get >50 Glu , I need to decrease dose in next shot, but what if the AMPS/PMPS are really high, should I still decrease the dose? For example, I gave 0.75 u and got 44 at +5 in the morning but 348 at PMPS, should I give 0.5 or 0.75??

Thank you~

 

[BJM]

...About the dose I still have a question. I know when a kitten get >50 Glu , I need to decrease dose in next shot, but what if the AMPS/PMPS are really high, should I still decrease the dose? For example, I gave 0.75 u and got 44 at +5 in the morning but 348 at PMPS, should I give 0.5 or 0.75??

Its if the BG is less than 50, ie <50, not greater than 50.

When glucose goes lower than usual or drops quickly, the body releases hormones to bring it back up. That is why you see the higher glucose at the next test. Its called a bounce. Ignore that and stick with the decrease that was earned.

 

[Cathy Chen]

Dear BJM,

Sorry I wrote it wrong.. it should be <50 not >50.

I will keep your words in mind and hope I can decrease the dose soon.

Thank you very much.

Cathy

 

[Deb & Wink]

Remember, the dose changes for lantus are based on the lows or the nadir somewhere mid-cycle, not the pre-shot tests.

Those bounces can last up to 72 hours, so give it some time to see the BG levels settle back down.

We want to keep Assam safe, so anytime you get a test <50, it's time to reduce the dose on the very next shot, at the next cycle. No need to wait to change the dose in that situation.

 

[Cathy Chen]

Dear Deb,

Sorry it me again.

Recently I changed the dose from .6 to .5 base on the number I tested at +5 which was 52.(Usually I feed Assam at +5 so she won't feel hungry during night, that's why I "assume" Assam's Glu will lower than 52 IF I did not feed her. I understand its risky...but seems the glu is doing fine? )

Here is my question. After changed the dose to 0.5, the AMPS/PMPS still stay around 250-300, I remember you said about "bouncing" of the Glu, I just wonder how you decide if it is bounce or not?

My vet says the dose isn't enough so the AMPS/PMPS keep higher, and she also suggests me to add some dry food at +5 so Assam's Glu won't go back to fast. Honestly...I really don't want to do this way...

I feel so confused but still have faith.

PS. Please teach me what does "patience pants" means??? :?

Thank you.

Cathy

 

[Deb & Wink]

Glad to see you lowered the dose, especially since you got that low of 52!

Cats can go lower, usually somewhere in the +5 to +7 hour range but it can be later or earlier in the 12 hour cycle. Yes, I agree with you that it's very likely Assam went even lower than that 52 reading you got.

My vet says the dose isn't enough so the AMPS/PMPS keep higher, and she also suggests me to add some dry food at +5 so Assam's Glu won't go back to fast. Honestly...I really don't want to do this way...

I would not give your Assam some dry food to bring the Blood Glucose numbers up. It takes too long to be digested and get into the blood stream to raise the BG levels. If you see those low numbers again, you should feed Assam some low carb wet food. Like a teaspoon or 2 of Fancy Feast classic pate or Wellness grain free.

There are a very few low carb dry foods that would be low enough for a diabetic cat. I'm at work and don't have access to that list. Where do you live? USA? Canada? International?

Patience pants means don't rush things. It can take time to see changes happening and we need to give ourselves time and wait for those changes to affect the progress of our diabetic cats.

I just wonder how you decide if it is bounce or not?

You can't always tell if it's a bounce or too much insulin. You get a feeling for it when you have reviewed countless spreadsheets from other members. Still, it's never 100% sure if it's a bounce or not.

It can normally take up to 6 cycles or 72 hours for a cat to get over a bounce, to clear a bounce. If they drop low repeatedly in the middle of the cycle, they can bounce for a long time, many days or weeks. Some cats can take many days to settle into a new insulin dose. It can take a week or longer.

Remember, the Lantus dosing chanes are based on those mid-cycle tests, not the pre-shot blood glucose levels. I disagree with your vet that this dose is too little. If anything,the insulin dose is too much for Assam. If Assam were my kitty, I would not change the dose again unless you get a really low number again, like down below 70. Then, you want to drop the dose again immediately.

Another reason to change the dose is if the mid-cycle numbers get higher and higher, it may be time to raise the dose. You are not in that situation right now.

 

[Cathy Chen]

Dear Deb,

Thank you for answering my questions,especially teaching me the meaning of "Patience pants"~

I am still feeding Assam the canned food instead of the dry food. But there is something different which is all my fiends says the dry food make the Glu goes up faster than canned food. So, if Assam is lower than 40, I always feed her some LC dry food instead of the canned food. This is way different than you told.

I live in Taiwan and don't have too many options for canned food. Right now I feed Ziwipeak 130g + Catsin/Catuna 160g each day. Assam has chronic pancreatitis so Catsin/Catuna are good for her (low fat). She is 12 years old and 3.5~3.6kg. She stills plays a lot and being a naughty girl everyday.

http://www.ziwipeak.com/?zpswlang=1 Ziwipeak website

If Assam were my kitty, I would not change the dose again unless you get a really low number again, like down below 70.

:?: According you said, I already tested 63 at 2/11 +5, should I change the dose from 0.5 to 0.4 or should I keep this dose and wait more days due to I got 199 at 2/12 +5?

I read many cat's SS as reference but they are pretty stable, their AMPS/PMPS and mid-cycle are almost the same, not like Assam's. I am not worried but just really want to know what happened to her and how can I help her. This is why I want to know what causes the bouncing. :?

Thank you very much.

Cathy

 

[Deb & Wink]

According you said, I already tested 63 at 2/11 +5, should I change the dose from 0.5 to 0.4 or should I keep this dose and wait more days due to I got 199 at 2/12 +5?

You have being really aggressive in the dosing. I'm afraid that Assam's glucose could be going even lower than what you have tested. We'd like to keep her safe and not get hypoglycemia.

I think it would be safer if you dropped the dose for Assam to the 0.4U or even a bit lower. I think Assam is bouncing, causing those higher numbers after she has dropped really low.

Bouncing is when the numbers go much higher, after they have dropped lower than the cat is used to. The liver releases counter regulatory hormones and some glycogen to raise the BG numbers back to what it thinks is a safe level. I think that is why you got the 199 on 2/12 at +5.

But there is something different which is all my fiends says the dry food make the Glu goes up faster than canned food. So, if Assam is lower than 40, I always feed her some LC dry food instead of the canned food. This is way different than you told.

Well, most cats don't chew the dry food into little pieces before they swallow it. This means the dry food needs to get broken down by the stomach acids into smaller and smaller pieces before it can be digested and affect the glucose levels. Before that can happen, the dry food needs to soak up moisture. Those 2 steps can take some time to happen.

The wet food is already in much smaller pieces and it's already moist. That means it will get digested faster and affect the glucose faster.

The dry food you are feeding may be higher in carbohydrates than the wet food. That would help the dry food to bring the BG levels back up.

What we do, is add a drop or two of a simple syrup like honey, pancake syrup, maple syrup, corn syrup to the wet/canned food. That increases the carbohydrate level of the wet food and helps to bring the BG levels back up.

I realize that you are posting here in the Relaxed Lantus forum, but there is some good information in the Lantus TR forum Stickies on handling low numbers. I think you should read this STICKY: LANTUS & LEVEMIR - SHOOTING & HANDLING LOW NUMBERS and print out a copy for you to refer to.

Here's a nice definition of what a bounce is and what happens to cause the bouncing.

Bounces - what are they and is my cat doing them?
When a cat isn't regulated, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". This can last a while. Months even.

But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.

 

[Cathy Chen]

Dear Deb,

Thank you for answering me again.

I think there is one thing I have to admit I really hope Assam can remission, but I also understand it takes times. So, I am asking cause I feel confused not because I am so aggressive in the dosing. I already made my decision, if Assam would need to take the dose for the rest of her life I would accept it. I just want her safe and happy.

The reason why I focus on dose is because this is the only thing I don't understand well. I already learned how to deal with hypoglycemia and also ready the information of "panic livers". That's why I know what bouncing is. However, I really don't sure the bouncing will cause the Glu back to a super high level, like over 500 or just a little higher than normal cat.(Some articles in Chinese said bouncing will case super high Glu). I am so confused because Assam seems have a little bounce on her Glu but not very obviously.

FDMB isn't the only website that I have been searching, many Chinese website are in my packet too, but still thank you for your teaching.

My English isn't good enough so I may not express my questions very well. I really appreciate your kindness and patience.

I will try to drop the dose to 0.4 and test couple days, hope this time she will have a smooth Glu curve.

Thank you very much.

Cathy