PLease could someone assess Alice SS - unpredictable!

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Julie and Alice

Julie and Alice

Member Since 2014
Hi,

I am sorry I haven't been able to keep updated here with Alice as we had a tragic death in family on the 9th May - still ongoing.
I have wanted to get back here. I've now updated her SS as in UK & needed to 'transpose' figures!
At night Alice started to need less and less insulin but then would have a high in the morning. This morning her BG was so low even though she only had a tiny bit of insulin last night. She appears well but doesn't want to eat, this is a first. I've encouraged her to have a few grams (Catz fine Lam & buffalo) - she licks the jelly & had a tiny bit meat with encouragement. I have not given her any insulin this morning - I had planned only yesterday to increase it again!!

I am hoping that her pancreas is improving but she is so unpredictable.
Any thoughts & advice appreciated please!

Julie
 
The BGs will go wonky when the insulin dose is changed constantly. We recommend sticking with the same dose consistantly every shot as much as possible and at 12 hours apart as much as possible. I would probably try a 0.50 dose and give her that morning and night and keep testing. You're doing a good job of testing. Some of those low numbers are from shots previously (like a cycle or two or three ago) as Lantus is a depot insulin. You don't want to make dose adjustments according to each pre shot test as Lantus does not work like that.

Because you're using the AlphaTrak it was a good idea to skip this morning's shot.

Please ask questions and I would recommend going over to the Lantus TR Forum and reading the Stickys at the top of the page and let us know if we can clarify some things for you.

Her numbers look okay in the evening, but she is bouncing in the mornings. We do not recommend increasing the shot because of a bounce in BGs.

I'm glad you came here to ask questions.

Keep getting better Alice cat_pet_icon
 
Hi there :cool:

My condolences for the tragic loss of your family member.

With Lantus, It's important to find a dose that you can shoot every 12 hours consistently.
Dosing adjustments are made based primarily on nadir rather than PS number.
Being that it's a long acting insulin changing the dose from cycle to cycle will result in inconsistent numbers.

I too recommend you visit the Lantus TR forum and read about the ins and outs of using Lantus as well the protocol used.
In terms of potential remission, Alice being newly diagnosed (< 1yr) is an advantage.
Make the most of it.
 
Thanks for response,

Unfortunately I know from experience with Alice now that she reacts completely differently in the night to the day even though her food intake is the same. She can go low in the night on very little insulin & seems to need more in the day. The problem is I cannot increase her dose at night without having to be up & give her high CHO food or even glucose. It just does not work for her to give the same at both 12 hour shots. She has suddenly changed to needing less insulin over the last few days. She had so little last night but was still very low for the first time at AMPS only to rise again several hours later during the day Although I understand its nice to find a consistent dose 0.5 would definitely be a rescue job for her at the moment if given at night! Her curves for day & night are like two different cats. I think she must be making some insulin of her own but running out over the day??? confused_cat

Really after several weeks of sleep deprivation & the unexpected death in our family I feel I just cannot function much longer like this. I am struggling to function at work & have to have a balance as my own health is now being affected. @-) When I go to work I cannot risk her going hypo although my husband looks after her he is not quite so 'tuned in' to the seriousness of a hypo and doesn't tend to do the BGs as often.

Perhaps there is no straight forward answer or explanation :roll: I was kind of hoping that this was a hopeful sign that she was recovering but I suppose its wait and see.

Thanks again for your time and advice

Juliex
 
Hi Julie,

Julie and Alice said:
...It just does not work for her to give the same at both 12 hour shots.
She has suddenly changed to needing less insulin over the last few days. She had so little last night but was still very low for the first time at AMPS only to rise again several hours later during the day Although I understand its nice to find a consistent dose 0.5 would definitely be a rescue job for her at the moment if given at night! Her curves for day & night are like two different cats. I think she must be making some insulin of her own but running out over the day??? confused_cat
Click to expand...

It looks to me like Alice is making some more insulin of her own.
That is a good thing in that it bodes well for further recovery; but it can also bring new challenges.

Sometimes insulin is produced fairly consistently and numbers get lower 'across the board'. (Hurrah!)
Sometimes insulin is produced in a more erratic fashion though: The pancreas works for a while, and then it doesn't. And then it does again... :roll:
It can happen that the injected insulin drops the blood glucose and then the pancreas seems to be able to 'pick up the ball and run with it' until it gets tired (at which point the blood glucose will scoot up).

If it isn't possible to find Lantus doses that work consistently for Alice then I do just wonder whether it might be worth your trying a PZI insulin? (That is, if your vet would prescribe it...?)
With PZI insulins it's generally possible to alter the dose and the timing of the shots far more easily than with Lantus.
Some cats do well on fixed doses of PZI, and some on 'sliding scales' where the dose is changed according to the preshot number (also taking nadir into account). You can shoot the number that you see (with the possible exception of a preshot caused by a bounce).

If you have to skip a PZI shot you don't have the problem of the insulin depot draining.

The PZI we have in the UK is Hypurin Bovine PZI. Like all insulins it is not without it's quirks: It's a long lasting PZI and the doses can overlap (one shot becoming effective while the previous dose is wearing off). But it still retains the 'flexibility' typical of PZI insulins.

I'm not saying that Hypurin PZI will work for Alice. But it might give you another option to consider...

Eliz
 
With a depot insulin, shooting early may act like a dose increase due to more overlap and shooting late may act like a dose decrease.

Given that, you might shift the shot times so its a half hour to hour later at night (slight reduction of effect) and the same amount earlier (slight increase in effect). For example, you might shoot a period of 13 hours for the day and 11 hours over the night such as 8 am and 9 pm. This would slightly reduce the overnight impact when cats are low and slightly increase the impact during the day.

With very careful testing to observe effect, you might be able to combine that with a slight dose adjustment down in the evening if that wasn't enough modification.
 
So sorry to hear about the loss in your family. :YMHUG:

My Neko likes to run lower at night, then she bounces during the day which makes it look like she is running higher during the day. I've tried changing everything to break her of that habit, but that's just what she likes to do. :roll: Remember that Lantus is dosed based on the nadir. On the morning of the 24th you saw a high number and increased her dose. Changing the dose is causing wonky numbers. In addition, due to the depot of Lantus, what you shoot one cycle may have a lot of influence on the following cycle. So if you shoot a higher amount in the morning when you see a higher number (bounce), you'll have too much insulin in her at the night when she wants to go lower. I recommend shooting .25U both morning and night for 6 cycles, then re-evaluating.
 
Thank you very much indeed!

I have reread several times to try & get this info into my haggled brain! Alice kind of threw me out again as I think like Eliz said, she is off & on with her own production of insulin! She was sick yesterday am & then no appetite & by PMPS too low to shoot at all! I knew she would eat well today (well I'm guessing that she will as she tends to catch up on a poor day) so I daren't reduce too low today. I think part of the problem is she is so petite so that she is affected by minute changes in insulin or food intake. Generally though I would say she is overall feeling much better than she was following the DKA beginning of March (when diagnosed). Her nadir has never been consistent even when her dose was!

Thanks for your advice again. I am chewing it over and trying to make sense of it alongside this little bundle of high intensity furry friend!

Do you know (by the way) how many people have tried to tell me to have her put down!! I don't know if others experience this. Someone told me a couple of days ago, "You don't have a cat, the cat has you" and proceeded to tell me that she needed to be put down - I don't think they have ever met Alice or knew any of the in's & outs of Diabetes in cats. Sorry, just a 'by the way'!

Thanks again & also for your condolences (my husband's son committed suicide :sad: )

Juliex
 
If you feel .25U is too low in the morning, how about trying .5U instead of .75? The last few days that .75U in the morning is making her too low in the evening for you to to feel comfortable to shoot a full dose. Lantus really does do best if you can get two shots in each day. Maybe trying .5U in the morning and evening would work?

Some people are just thoughtless when it comes to talking to people about pets. Diabetes bring us even closer to our cats. And all the loving care you are doing for Alice is making a difference. :YMHUG: Her insulin dose is coming down.

Condolences to your husband too. Losing a child like that must be so hard. :cry:
 
Sems like you have some folks who don't understand boundaries.
It is your cat, not theirs. If you wanted advice from them, you'd ask for it.It isn't their decision.

And you can politely ask them if they'd like to be 'put down' when they if they or a loved one has or eventually develops a chronic medical condition such as heart disease, COPD, Alzheimer's, renal disease, diabetes, etc., as they get older. Grrrr.


Is your husband talking with anyone experienced - pastor, priest, counselor, doctor? Family members of people who commit suicide are at an increased risk for problems themselves.
 
Thanks Wendy & BMJ!

Good advice as usual! Well first, Wendy, I think you are right, sometimes its hard to see the wood for the trees. After another night on the tiles (3 hours sleep!) I have reduced her morning dose to 0.5 units. I'm not sure that I feel I can immediately increase her night dose to the same today but will see how she goes. At least it should allow me to give her some hopefully! She had 0.1 I think last night - plunger just sitting under the first zero line with no light under it & we found a 3.3 ie 59, and so another panic! We would have tested a little earlier but we had an unexpected visitor. It was only start of the cycle too, amazing on such small amounts. :o

Thanks for support too and suggestions BMJ re suicide. I immediately did a google & tried to see the best way to help my hubby. I had kept trying to add a positive to his depressed thought to lift him a little but I read that it is better just to let him talk and feel the pain. I cant see a support group here. We did have a lady come (the unexpected visitor) last night who's brother did the same 10 years ago, we did know him and it was good to talk to her, her brother was so similar in his struggles. I said this morning to my hubby, "its like he's emigrated without saying goodbye". You never know what pain someone might be suffering - a lesson to me to always LISTEN & ask questions if someone seems to be sad or struggling.

On that poignant note,
THANK YOU XX
Juliex
 
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