Questions about Lucy's curve today

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123joan

123joan

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Hi everyone,
First, I have to ask:
Is there ANY CHANCE that the miniscule bit of water packed tuna (I mean as small as a cat treat) I give Lucy after each blood glucose test is making her numbers go up during the day?
Now, I go: Obsessing.
Maybe today was the wrong day for me to choose to do a curve. But when is the right day? She seems to be feeling just fine.
Are her higher numbers relating to the lower numbers she had on 2/3/13? Should I be trying anything new? Did I make a mistake giving her insulin when her PMPS was 1t 168? I predicted that feeding her would cause her level to go up. I did not test later that night. In hindsight I know I should have. I had to feed them, couldn't wait any longer for dinner time.
I'm going to drop her numbers off at the vet tomorrow, I'll include her numbers from the past week or so. In an abbreviated form. I think if she looked at the REAL spreaadsheet she'd swoon.
February 6, 2013
5:45 AM 273 1.4 units ProZinc
8:00 AM 379
10:00 AM 358
12:00 PM 366
2:00 PM 410
4:00 PM 374
Stay tuned for PMPS!
 
I wouldn't worry about the tuna. It sure looks like an inverse curve or a bounce from lower numbers overnight. Problem is I can't tell which. The yellow preshot this am could have meant she dropped fairly low overnight. The high nadir could also be an inverse curve. Both would be indicative of a dose higher than needed.

I will admit her patterns are really confusing, Joan. She seems to do better on a lower dose, than better on a higher dose. And I think we have tried a sliding scale also. The one thing that might make the picture clearer are some night time nadirs. If she drops down at night, maybe that causes wonkiness in the day?

Let's see what others think. Can you get a few night midcycle numbers?
 
Hi Joan,

In general. Looks like her AM dose is not enough. But the oddball low PS numbers have me confused. She could be going low at night? It could be you might need to give her a different dose day and night.

Here's what I would do. You don't have to run extensive curves either. Pick a day or two when you can test somewhere in the middle of both cycles. Even if you just need to see a middle of the night alarm to test and go back to sleep.

Try a higher dose in the morning. Like 1.8? Test her at AMPS, test her again at +4 to see if she's dropped a good bit. If so, test again at +6 or +7 and try to catch nadir.
Then test PMPS. If the number is close to the AMPS, shoot maybe 1u. Set an alarm for +5 or +6 and test her.

Next morning, see what sort of AMPS you get. Then try to see if the numbers make any sense.

There are a couple of kitties (Lisa's Cass is a good example) who get pretty different numbers on small dose adjustments of .2. But I generally believe that most cats don't, and that the fluctuations in numbers on tiny adjustments are due to "something" else than the tiny dose difference. I know that I'm in the minority thinking that way, but that's what I think.

I believe that in order to be at all conclusive, the difference in dose amount needs to be significant enough to "know it made the difference".

I can't tell other people to do things the way I do (or did) them. I think I'd be more aggressive than most if Bob's numbers cause him to fall out of remission. I'd try to "force greens" by making the dose large enough to do that, but at the same time, do so safely. I'd use food to stop him from going too low rather than reduce the dose. I understand that is counter to what other people advise, but that's what I'd do. And only because it would be me right there intervening when things got dicey. I wouldn't give advice to somebody else and leave them having to deal with the consequences of my aggressive advice.

Carl
 
Her numbers did indeed go down during the night.
Nice curve in the middle of the night, LUCY!
I upped her dose to 1.8 this morning. I'll update with a couple of numbers later this morning and afternoon.
AMPS 02/06/2013 5:45 AM 273 1.4 U Prozinc
8:00 AM 379
10:00 AM 358
12:00 PM 366
2:00 PM 410
4:00 PM 374
PMPS 6:00 PM 331 1.2 U Prozinc
10:15 PM 222
1:45 AM 191
AMPS 02/07/2013 5:45 AM 289 1.8
I cannot understand why a higher dose could yield higher numbers. I don't think the tiny increments affect her, I think adjusting by tiny increments makes me feel as if I'm actually doing something. Often just staring at the chart and putting off making a decision.
Have people had success with different AM and PM choices?
Should I start a new thread with today's readings, or keep this one going?

Thank you everyone for this group consultation.
 
This thread isn't" long" so no problem keeping it going.
Carl
 
8:00 AM 379
10:00 AM 358
12:00 PM 366
2:00 PM 410
4:00 PM 374
PMPS 6:00 PM 331 1.2 U Prozinc
10:15 PM 222
1:45 AM 191
AMPS 02/07/2013 5:45 AM 289 1.8
+4 223
Going down a little bit. Better than up.
 
It does look like Lucy prefers less insulin rather than more.

Carl, steering the numbers with food sounds like standard Lantus protocol. While it would work the same way with Prozinc it would only be worth trying IF AND ONLY IF you would be there to moniter the curve and step in with food if necessary, I wouldn't advise it for someone who works away from home all day. She could try it on a day she is home and able to moniter.
 
I sure don't know what to do. More? Less? I can take readings today. This morning's dose was .4 units higher than usual, last night's .2 units lower. This is over my head. I'm going to wait until tomorrow to deliver charts to vet. I have to be out of town Sunday thru Monday and have pet sitter for Sunday PM and Monday AM shots. Sitter won't test, and I don't even know what I'd tell her to do if she DID test. Since I barely know what to do myself. What I have to go through for 24 hours away from here. Oh quit complaining.
 
AMPS 289
+4 223
+6 158

If she stays low at PMPS should I give her reduced dose?

I'll be posting her + 8 and or +10
 
+10 331

Assuming her numbers keep rising, what about a reduced dose of 1.2 for this evening again?
 
A PATTERN. Music to my ears. Hasn't happened yet.
I will get up in the middle of the night again tonight to check her out.
 
123joan said:
Off topic: Carl: Nice strat! When did Bob learn to play?
Click to expand...

LOL, Bob has been playing for years! He's better on keys, though. :smile:
 
Rob & Harley (GA) said:
It does look like Lucy prefers less insulin rather than more.

Carl, steering the numbers with food sounds like standard Lantus protocol. While it would work the same way with Prozinc it would only be worth trying IF AND ONLY IF you would be there to moniter the curve and step in with food if necessary, I wouldn't advise it for someone who works away from home all day. She could try it on a day she is home and able to moniter.
Click to expand...

I absolutely agree. Using food works great with Lantus kitties, and I think it could work well for any type of insulin. The people using Lantus that use the "steering with food" are doing it while monitoring (which is logical because if you're steering with feeding, you have to "be there" to do it, so you're there to test often at the same time). It should, as Robin points out, only be used as a tool if you can be there to monitor, because you have to know when it is needed by testing and monitoring the drop in BGs. We do routinely suggest, however, that people use auto-feeders to feed their cats during the hours they are at work or while they're sleeping. It's more or less using the same "strategy" because the purpose is to avoid mid-cycle lows when you can't be there to test.

If Bob were to regress, or if I ever have another sugarcat, I would most definitely use food to steer the curves. Because my goal would be to "force green numbers" (or at least force the numbers below the renal threshold) for as many hours of a day or night as I could. Every cat, no matter which insulin used, is going to "bounce" from low numbers - even numbers that aren't necessarily "low".

There's only two ways that I know of to avoid bounces. One is to not use enough insulin, and rarely if ever see low numbers. The danger there is letting the cat stay in numbers that are going to increase glucose toxicity and insulin resistance.
The other is to get them accustomed to "low numbers" so that they will stop bouncing when they happen. So if I had to use food to let him drop to 60, but not drop any lower? I'd be all over that. But I wouldn't tell you or anyone else that you should do that. There's a risk associated with doing it, and while I might be perfectly willing to put my own cat at risk, I'm not willing to put your cat at risk. I'm merely pointing out that it is an option that many people have had success with.

Carl
 
I failed. Didn't get up in middle of night. Tested at +4.5 and her glucose level had risen, or was virtually flat. Will try the increased dose today and see if she does as nicely as yesterday. And promise to set a clock tonight for a plus seven or so in the wee hours. A legendary storm is about to hit the east coast, it sounds ominous. We are safe for now here in Appalachia.
(yesterday)
PMPS 347
+4.5 353
(today)
AMPS 353 (1.8u).
 
I had a hard time with overnight testing too. I was just hearing about the storm heading your way, it sounds scarry. Be sure you're stocked up on essentials, test strips, food, etc.

Also, while you are away for the Sunday-Monday with a pet sitter who is shooting but not testing I would have her lower the dose to be safe, it would be better for Lucy to be higher for a day than low and nobody knowing about it.
 
I've been checking Lucy a few times during the past few days. It seems like she is always too high. I am worried about her, she shouldn't have numbers so high all the time. We are going out of town tomorrow through until Monday. I will be worrying, I just don't know what to do next. I will ask the pet sitter to give her 1.2u both am and pm, I think that will be safe
It doesn't seem right to keep checking her glucose levels on and on and on but what else can I do? Nothing seems to work. I'm still feeding her three times a day, 1 1/4 cans FF am, half can noon, and 1 1/4 can dinnertime (pmps).
I will talk with my vet Tuesday.
 
I agree with shooting a lower/safer dose while the petsitter is there.

I don't know Joan, but I can hear your frustration loud and clear. Some days, it looks like the insulin just isn't doing anything.

I have a feeling your vet may suggest upping the dose. One thing you might consider is asking the vet about a different type of insulin? Find out if they have any experience with another one, or if they even think a switch makes sense.

Carl
 
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