P - AMPS 351, +8 294

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Melissa and P

Melissa and P

Member Since 2014
Yesterday: http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=113667

Looking just a little bit better than yesterday -

AMPS: 351- fed 3/4 can FF turk and gibs, not quite 1 tbsp. boiled chicken
+4: 387 - Fed 3/4 can FF chicken
+5: 382
+6: 402 - food spike, not as bad as usual!
+7: 359
+8: 294 - nadir later again today
+10: 359 - already on the way back up

I decided to feed at +4 instead of +5 so he could have a better chance at having his nadir earlier. But it looks like he usually has his food spike two hours after eating. Is this "normal?"
 
I'm wondering if this could still be a case of glucose toxicity. I expected him to go down a little faster if that was the case, but I guess with his bounce last night (and possible, probable?) bounce he might have tonight, it still could be glucose toxicity. And once we get over the bouncing, he'll start downward? I'm also wondering about that late nadir.

Just throwing out some thoughts. Trying to get a handle on all this stuff.

I'm thinking I'll stick with the 3.5 again tonight, and monitor closely.
 
How long till your shot Melissa? I'm leaning towards either holding the 3.5u another cycle, or going up to 4u.

Even though it looks like P probably bounced last night, it wasn't due to a super low number. There's lots of room to go down from there if you decided to increase.

I'll try to locate some reading materials for you on the glucose toxicity and insulin resistance. The gist is that the insulin just isn't being used effectively by the cells to help utilize the excess blood glucose. Kitty may only be actually using a rather small percentage of the insulin that's going in, and that's the resistance part. The cells are "immune" or "resistant" to the hormone effect of the insulin. The thought process behind "breaking through" the glucose is that eventually, the insulin you are injecting eventually wakes up those receptor cells and they use the insulin more efficiently and effectively to utilize the excess blood glucose, so then you see lower numbers on your meter.

From a practical standpoint, it's my understanding that it's rarely an overnight process to get to a level that's enough that it starts waking up those receptor cells to "break through" the toxicity/resistance. But when a kitty hits that "magic" point, sometimes those receptor cells start working properly, and that's where the doses start coming back down the scale. I do want to say that this is definitely outside my wheelhouse, and I'm definitely no expert, so it's entirely possible that I'm totally wrong about P demonstrating some glucose toxicity/resistance.

You might take a look at Sandy and Black Kitty's history. Black Kitty was diagnosed as insulin resistant which is different than insulin resistance caused by glucose toxicity, but you can at least see the idea happening there. She went up and up and up on the dose scale till finally something clicked, and the insulin started working more efficiently for Black Kitty and he came back down the scale and went OTJ. That's not to say that you will need doses anything like BK, but it may take a while before he's coming down into good numbers. You know the mantra -- it's a marathon, not a sprint. :mrgreen:

I think what you might be seeing with the later nadirs is that the insulin is bringing down the BG from the food spike but it's not getting much more done than that. My understanding is that the food will start to numbers roughly 30 mins to an hour after eating, and can hang around for 4 hours.

I definitely encourage others to chime in on this. Mel, do you know any current Lantus/Levemir users that were high-ish dose on PZI or ProZinc and subsequently switched? Or maybe some other L users that got up into higher numbers before coming back down the scale?
 
Well crap. I fed and shot before I read your post. I held at 3.5 but an increase sounds like a good idea, if nothing significant happens tonight. I just don't know when the right time to increase will be. I don't think I should do 4u tomorrow morning because I will be at school for several hours and no one will be home to monitor. It might have to wait until tomorrow night.

I thought that since we saw a lower number, that meant he should be going down. But I see what you're saying. There's still room to increase, to hit that "magic" number to get more of a decrease. Now that you've got me straight on glucose toxicity, I do think it could still be the case because he had had lower numbers before, on smaller doses, but then he got stuck and now we're on the increase.

I'll definitely take a look at Sandy and Black Kitty. I haven't been following any of the L land users, but I did pop in last night and started looking around.
 
Melissa and P said:
Well crap. I fed and shot before I read your post. I held at 3.5 but an increase sounds like a good idea, if nothing significant happens tonight. I just don't know when the right time to increase will be. I don't think I should do 4u tomorrow morning because I will be at school for several hours and no one will be home to monitor. It might have to wait until tomorrow night.
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No worries. :smile: With P's numbers, I think you can probably go up every three or four cycles, depending on what kind of nadir he's getting, how much he's bouncing, etc. Hopefully, he'll start coming down a bit more. I think it's a good idea to wait to increase till you can monitor, just in case P decides to surprise you. :-D
 
That analogy is brilliant. I love articles like that; easy to understand. Great find :smile:

I haven't decided whether or not I'm going to go to all my classes tomorrow. I didn't get a good nap like I wanted to today, and I plan on being up until at least +7 tonight, so I'm low on sleep. If I decide not to go, I think I'll increase to 4 in the morning.
 
Possibly. Or it's just not going to go quite as high, and (anti-jinx) maybe P won't bounce. :-D Shaping up better than last night.
 
Awesome :-D

I've decided to go to class, so if he doesn't go too low tonight, I'm going to stay at 3.5 in the morning, as long as he is in the 300s preshot. I think I'll drop to 3 if he's in the 200s.
 
Melissa and P said:
I've decided to go to class, so if he doesn't go too low tonight, I'm going to stay at 3.5 in the morning, as long as he is in the 300s preshot. I think I'll drop to 3 if he's in the 200s.
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I think that sounds like a good plan. Hopefully P will see a couple more yellows yet tonight. :smile: I'll keep an eye out for another hour or so. Do you know how to feed lower numbers on the off chance that you see something under 100?
 
I think it's probably pretty unlikely that P would dip low, but I want to make sure you have the tools you need *just in case.*

Here's the LOW numbers instructions - specifically below 50. http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=61799

What I do for Eddie if he's sliding a bit faster than I'd like, now that I know his patterns, or if he's had a steep drop over the course of an hour into the 60's or 70's and he's before his usual nadir, I will usually feed him about a tablespoon (or less) of his regular low carb food. That gives the insulin something to work on, and I will test roughly every half hour and feed 1/2 to 1 Tbsp. of his FF to keep him from going lower than I want him to if he's still going down. If he's staying steady or going up a smidge, I might feed a little every hour rather than every half hour. You do not want to overfeed, just in case you have to keep feeding the numbers. You also don't want him to eat too much and vomit. To see an example of this, check out the Eddie's PM cycle on 2/10. The food notes are the last column on the right side, after the comments column.

Guiding with food is also something you can do with practice when P starts seeing better numbers when he's lower, and it's something you've been experimenting with to try to smooth out that early cycle rise. :smile:

If you were to see numbers in the 50's, definitely post in Health with a 911 and something in your subject line with the number and a request for help. There should be at least one or two people able to talk you through it.

Since P is sitting in the 300's and 400's, I'd suggest testing in half hour increments if he reaches 100 or lower, and since he hasn't seen numbers like that in a long time. Upper 100's you shouldn't need to worry. Hourly should be good with numbers in the high to mid-100 range.

Two rising numbers without food influence is usually OK to relax.
 
Melissa and P said:
+6: 358 - Slight increase from +4, after feeding.
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Not bad. Looks like P's not going to bounce tonight and no big rise from the food. :smile: See ya in the AM!
 
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