Ok, but general help needed - 9/16 Dweezil AMPS 400s and all day high but then SO LOW that night!

[monty_dweezil (GA)]

Well, today's numbers have sucked all day! It's after 4pm now and by now he would usually be dropping to reach his nadir, but he seems to rising instead.

This AMPS was the third cycle of being on a 1.5 unit dose.

Last night's numbers were great, though I did keep a slightly nervous eye on him during those green numbers. He enjoyed his normal low carb nightly snack during that time.

 

[Chris/China (GA)/Garfield]

Here's your previous post.....we like to have the link to the prior day's thread put into the current one so it's easy to go back and see what's been going on.
He's bouncing from his low numbers last night

Bounces don't always go straight up and then straight down......they can "wobble"

Just hold the dose and let's see how it goes! Bounces can last up to 6 cycles, so today's was just the 1st

 

[monty_dweezil (GA)]

I have a question too. It seems that sometimes Dwee's AM shots don't start to really work until +8 hours and then he hits his nadir around +14 hours.

But his PM shots seem to do the opposite and start working quickly and his nadir is between +3 and +6 hours, and then he rises up high again for the remainder of that cycle.

So that's 4 problems I can see...

1. Most of each day his numbers are too high from shot time to +8.

2. Some of each night his numbers are too high from +6 or so onward.

3. His AM nadir is after his PM due dose time which makes things awkward, but his PM nadir time is much earlier.

4. Sometimes his nadirs are too low (green) which suggests a reduction is earned. But surely a reduction is NOT wise if half the day the BG is high?

Basically from 3pm until 3am his numbers are good. Blues, yellows and a few greens. So half the day. But from 3am to 3pm he's mostly pinks, some reds and some yellows.

He eats the same food at breakfast at shot time at 5.30am and dinner at shot time at 5.30pm (if he's not too low for his shot then) and has a small low carb snack at about noon and another at about 9.30pm. The foods don't seem to push him up. Last night when he was green I gave him his normal snack, and he remained on the border of green and blue for hours after that.

During the times of 1am to 5.30am he sleeps soundly in bed with us. Then has breakfast. Then goes back to bed from 6am unil 11am. Sleeping all that time on the bed. No eating during those times. High numbers usually here.

From 11am or so until 4pm he is dozing / having his snack / wandering around / sometimes playing, watching bird outside TV, and generally a bit more active. After that is when his BG usually start to go down finally from the 5.30am shot.

Later, dinner at 5.30pm, then dozing and relaxing on the couch until 9.30pm and then snack time. During all that time he is low rather than high. Stays low into bed time at 1am though does tend to start to climb up around that time.

Is sleeping causing high numbers!? lol

 

[Sandy and Black Kitty]

Are you monitoring for ketones? (I'm gonna keep asking...)

Dweezils 09/15/PM cycle was lovely. No late nadir, no double dip or dropping number at AMPS

Well, today's numbers have sucked all day!

As I mentioned yesterday, his body is perceiving last nights lovely stretch of numbers as dangerous and reacting by releasing counter-regulatory hormones to bring BG back up to what it has become accustomed to. As he spends more time in the healing numbers (50-120) his counter-regulatory system will eventually clam down.
As hard as it is it's important that you wait out the temporary bounce to higher numbers before evaluating for possible dose changes. it can take up to 6 cycle so patience is key.

You now have 3 consecutive cycles at 1.5u. Since nadir is under 100 you want to hold this dose for at least 10 cycles before increasing.

Sometimes his nadirs are too low (green) which suggests a reduction is earned. But surely a reduction is NOT wise if half the day the BG is high?

With Lantus, dosing is based on nadir. It is not an insulin used to shoot down high numbers.
If you are following TR, the reduction signal for a long term diabetic (over 1 year since dx) is a dip under 40. For a cat who has been diabetic less than a year it is a dip under 50. In either case you reduce by .25u , even if you know (or think you know) there will be a big bounce coming.

With any diabetic cat being treated with insulin, data older than about 2 weeks back is pretty much ancient history. Additionally inconsistent dosing muddies the waters making it nearly impossible to achieve the sort of patterns that promote healing.

Focus on consistency and following the guidelines and before you know it you will have some solid data under your belt - data that will tell the true story and guide you in laying a solid foundation toward healing and the best possible quality of life for your kitty.

 

[monty_dweezil (GA)]

Ok...I must be patient! lol.

What about with these 1.5 cycles, if many of them contain greens and he's been diabetic for almost 3 years, should I still wait for 10 cycles?

Oh and yes. For almost 3 years we have stuck a keto-diastick under his "area" and gotten a quick sample at least once a day. My partner hovers around after his breakfast for his post-meal pee, then often he'll pee at some stage around 3pm, then maybe after dinner, and then each night around 1am we come to bed. I do my pee (sorry for TMI. lol) while he eats the rest of his snack, then I brush my teeth and he almost always pees then. Never any ketones. If ever even a trace was seen, he'd be encouraged to drink while we called a cab to wisk him away to the vet asap.

 

[monty_dweezil (GA)]

Now he has dropped well into the greens and his normal low carb snacks aren't making a difference. Just had to give him some higher carb wet food.

I just feel I shouldn't have to be doing this to keep him safe each night. 1.5 seems too high. Tonight. And last night. And the night before he was too low too.

1am now. It has been 7.5 hours and still he is low green, around 40s, and won't rise on his own. He seems normal and relaxed. He's had some special Greenies treats only usually reserved for Monty as they have carbs, he's had many dry food portions of diabetic biscuits, and he's had two portions of a higher carb Fancy Feast can, and yet he only ever rises a few points and then drops back down again.

Now we're going to bed with another higher carb pouch of wet food.

I am not happy with this repeated 1.5 dose. I am stressed out every night and spending all night scanning and feeding to try to keep him safe. He should not be this green every night and he should not be having to eat high carb food, and even that doesn't do much to help.

 

[Tricia Cinco(GA) & Harvey]

According the TR sticky, normal BG numbers for a cat are 50-80 on a human meter, so last night's numbers are just what you want. Unfortunately, as has been mention, Dweezil's body just isn't used to that, so it panics and throws him into a bounce. The good news is that, usually, the more time the kitty spends in green numbers, the more the body starts to adjust to them, and the bounces should lessen in size and duration. Lucky you that Dweezil prefers to dive at night, but that is not at all uncommon.

When in the cycle did you start with the higher carb food? Perhaps the next time you see him starting to drop, you should give him something higher carb (do you have any MC say 9-12%?) and see if you can just get him to surf, since LC isn't doing it. You had him surfing last night, just a smidge lower than is preferable, and you say you had to use HC to accomplish that, but it sounds like you didn't switch from LC until he was at or near his lowest point. If Dweezil really needs a reduction, he will earn it despite what you feed him. He might be headed there, but he isn't there yet.

For almost 3 years we have stuck a keto-diastick under his "area" and gotten a quick sample at least once a day. My partner hovers around after his breakfast for his post-meal pee, then often he'll pee at some stage around 3pm, then maybe after dinner, and then each night around 1am we come to bed. I do my pee (sorry for TMI. lol) while he eats the rest of his snack, then I brush my teeth and he almost always pees then. Never any ketones. If ever even a trace was seen, he'd be encouraged to drink while we called a cab to wisk him away to the vet asap.

Excellent!!!!

And last night. And the night before he was too low too.

72-90 is not too low. Some people (like Chris) would even think it was bordering on too high! Those are perfectly safe, acceptable numbers. I recognize that if you aren't used to seeing them they are scary, but honestly, they are great!

 

[Sienne and Gabby (GA)]

What is the percent carb food you are feeding Dweezil? Another alternative is to use a food that is still low carb but higher in carbs than what you're currently feeding.

Another consideration is that the TR Protocol is aggressive. If you are uncomfortable with the parameters of this method, you can always consider using Start Low Go Slow. The reduction point on SLGS is 90.

 

[Govies mom (Karen)]

I have a question too. It seems that sometimes Dwee's AM shots don't start to really work until +8 hours and then he hits his nadir around +14 hours.

But his PM shots seem to do the opposite and start working quickly and his nadir is between +3 and +6 hours, and then he rises up high again for the remainder of that cycle.

So that's 4 problems I can see...

1. Most of each day his numbers are too high from shot time to +8.

2. Some of each night his numbers are too high from +6 or so onward.

3. His AM nadir is after his PM due dose time which makes things awkward, but his PM nadir time is much earlier.

4. Sometimes his nadirs are too low (green) which suggests a reduction is earned. But surely a reduction is NOT wise if half the day the BG is high?

Basically from 3pm until 3am his numbers are good. Blues, yellows and a few greens. So half the day. But from 3am to 3pm he's mostly pinks, some reds and some yellows.

He eats the same food at breakfast at shot time at 5.30am and dinner at shot time at 5.30pm (if he's not too low for his shot then) and has a small low carb snack at about noon and another at about 9.30pm. The foods don't seem to push him up. Last night when he was green I gave him his normal snack, and he remained on the border of green and blue for hours after that.

During the times of 1am to 5.30am he sleeps soundly in bed with us. Then has breakfast. Then goes back to bed from 6am unil 11am. Sleeping all that time on the bed. No eating during those times. High numbers usually here.

From 11am or so until 4pm he is dozing / having his snack / wandering around / sometimes playing, watching bird outside TV, and generally a bit more active. After that is when his BG usually start to go down finally from the 5.30am shot.

Later, dinner at 5.30pm, then dozing and relaxing on the couch until 9.30pm and then snack time. During all that time he is low rather than high. Stays low into bed time at 1am though does tend to start to climb up around that time.

Is sleeping causing high numbers!? lol

I'm reading your story and realizing I'm going through the exact same thing you are so I'm watching what everybody responds to your story and apply to myself!

 

[monty_dweezil (GA)]

The problem is that if I don't feed him any HC food, he goes LO and then I don't know what he is.

I am not on tight regulation. We have this monitor on but not constantly.

He stayed green most of the night and then was in the blues this morning for his dose but is now up in the reds again.

 

[monty_dweezil (GA)]

I feel sad for him. I worry he is unhappy by one minute feeling weird and hungry when he's green, and then the next day feeling weird and thirsty when he's pink.

 

[Red & Rover (GA)]

Part of the problem could be the inconsistency of the dosage. You need to find a dose that will keep him safe and be given consistently. Lantus is a depot insulin. It craves consistency. It is not generally used on a sliding scale.

Greens above 50 are good greens. (That 49 could easily be a 50 given meter variance.)

 

[Chris/China (GA)/Garfield]

He stayed green most of the night and then was in the blues this morning for his dose but is now up in the reds again.

That's just because he's "bouncing".....Bounces happen because they 1. drop too low 2. drop too quickly 3. drop lower than their body is used to (or a combination of all 3)

In Dweezil's case, his body has become used to living in those higher numbers, so dropping into what is a "normal" number feels wrong to his body and his liver releases stored sugars and hormones to bring him back up to where it's "used to" being......he "bounces"

It can take up to 6 cycles (3 days) for those hormones and sugars to clear back out of his body, so we don't want to increase just because he's in a bounce.

As his body re-learns that it's OK to be in those better numbers, he'll hopefully stop bouncing as high and when he does bounce, he'll clear them faster

It's totally normal and in some ways it's good....at least you know his "self-preservation" is in good working order!

 

[Sandy and Black Kitty]

You will find the SLGS method explained here.
Also please update your signature block to reflect you are following SLGS. If later you want to switch to TR it's no problem.
I see you took a reduction to 1.20; regardless of which method you follow, reductions are taken in .25u increments.
Do your best to draw 1.25u for the next dose, the important thing is that you be as consistent as possible in the amount of insulin you pull for your 1.25u.

The problem is that if I don't feed him any HC food, he goes LO and then I don't know what he is.

Please read about dealing with lower numbers here where you will find guidance regarding what to feed and when.

Doing what needs to be done to treat your kittys FD can be very daunting.
The FDMB is the best place a diabetic kitty can be.
We have all lived it.

It takes commitment, it takes endurance and lastly, it requires a certain 'leap of faith' that all these crazy cat people know what they are talking about.

 

[monty_dweezil (GA)]

Thank you! Today is basically so far an exact repeat of yesterday so I'll update my SS soon and start a new thread.

I read the guide to dealing with hypos. We have been through 4 sympomatic hypos in almost 3 years, always early on in the cycle. We always thus assumed his nadir was early, but with the monitor we now know it's late, the AM nadir anyway, so those +4 hour symptomatic hypos were all actually hypos overlap from the previous dose.

We would know then what to look for as he would seem normal but his eyes would look through things instead of at them, his eyebrows and whiskers would twitch and he would look around as if seeing things that weren't there. The first one of these after dx in December 2014 was in July 2015, and the most recent one in June 2016. The numbers tested once at the vet to treat him were around 1.5-3.5.

Anyway, since wearing these monitors, he's been apparently at 2.2 and lower "LO" and yet seemed normal. His normal food does not lift the numbers at all. I find it odd that he used to be visibly low on numbers higher than ones he has now and seems perfectly fine.

Usually his AM nadir is late, at 7pm or +14 hours. Usually his PM nadir is earlier, at 11pm-1am or +6-8 hours. Why, we don't know. His food is the same for both meals. His activity level is much the same. He is an indoor only pampered furbaby.

I am still full of questions even after reading these guidelines.

Why did his AM nadir today and yesterday not occur late, like the ones prior?

At the +12 hour shoot time, it says if the number is low but higher than the +10 or +11 number, then it should be safe to shoot. But shoot what? The regular full dose, even if the BG has just started to rise and is still low?

It also says if the +12 number is lower than the +10 etc and is dropping, to delay. Which I have done several times. At +12 hours he has often been 6 and and +14 he will be 4. I delay after the 12 hour time. And delay. And eventually I must feed my boys their dinner. Still dropping. After +14 it sloooowly starts to come up, but not until it's now quite a few hours late for his PM shot. Even then the number is low and I fear giving a full dose.

Is there any logic to the question of whether if a full dose of 1.5 units can drop a pre-shot BG from red numbers to green in 3 hours, what on earth would it do to a a pre-shot BG in the low blues? Send the BG into minus numbers!?

Oh, and when I say a dose of 1.2 units, it may as well be 1.25 as right now my syringes only have 1 unit markings. Anywhere between 1 and 2 looks like 1.5 so we just do our best. A tiny bit over 1, we call 1.2 and a tiny bit under 2 we call 1.8 or so, but really...it is certainly not able to be so exact as to say 1.25.

I have forgotten the other questions for now, but I'll be back. lol.