Sabrina AMPS 518, PMPS 304, +4 117-What's going On?

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milfordcollector

milfordcollector

Member Since 2012
Evening! Please look at Sabrina's SS & give me your opinions on what's going on confused_cat I did her curve yesterday & submitted the SS to the vet.....said they'd have someone call me tomorrow Re: dosage adjustment nailbite_smile I just don't undestand why her numbers were so high yesterday.....sick? but I'm leery about adjusting her dose right now if they tell me to. Thank you & the forum for walking me through this confusion Cind & Sabrina cat_pet_icon
 
Cind,

First, can you get a +5 test?

I think what you are seeing today is a "bounce" clearing. Possibly on the PM cycle on the 28th, Sabrina's BG numbers went lower between that last test you got, and the AMPS the next morning. When that happens in most diabetic cats - when they see a number that is much lower than what their bodies are used to - it can trigger an instinctive reaction between her pancreas and her liver. The end result is that the liver will "dump sugar" into her bloodstream, because it senses that her BGs are too low. (They might not be too low, but as far as she's concerned, they are). We call that process a "bounce". It can take 2 or 3 days before the glucose and hormones clear the system. Which is why we call this "a bounce clearing". Not sure if you were already aware of this, so if you were, I apologize for thinking you might not have been.

When a bounce clears, what you're seeing tonight can happen. A fairly quick drop in BG in the first few hours after a shot.

What you want to check is if the numbers keep falling. If they do, you keep a close eye on them, and at some point you may have to intervene by feeding her to slow the drop in BGs down. That's why I'm suggesting a +5 test.

If you can do that, post the number?

Carl
 
I agree with Carl. The 160 on 1/28 may not have been the lowest that Sabrina went during that cycle. Regardless, it looks like her liver and pancreas panicked and she bounced. Tonight, it looks like the bounce is clearing. Getting another test would be a good idea!
 
welcome!

I see a few possibilities. As you start to gather more data, it will be easier to narrow things down.

First, Sabrina is responding very well. I know the high preshot numbers can be frustrating, but she's also getting into the 100s sometimes, so that's good.

About this morning's high, there are a few possibilities. One is that some cats have a pattern that we call "high before the break," in which they throw a random high number just before their numbers drop. Seeing it happen one time isn't enough to be able to say for sure that this is a pattern of hers, but it's something to watch for to see if she does it again.

Or, it's possible that today she was coming out of a bounce. Cats can bounce up high after they hit lower numbers than they are used to, or even just from dropping fast even if the numbers aren't that low. The reason is that when the BG drops low, the body's response is to panic and think "i'm about to hypo!" and release counterregulatory hormones to protect the cat from hypo. It doesn't even matter if they are really headed toward hypo, bounces can happen if they drop into numbers they aren't used to. Those hormones can take anywhere from one cycle to three days to clear out. We just ignore the highs and wait until they clear.

So it's *possible* that Sabrina could be bouncing from some lows the evening of 1/28, or maybe even last night. Normally a Lantus curve would have the number at +2 be about the same as the number at preshot. Her +2 that night was lower than her preshot, then the numbers head down until nadir, so chances are she kept going down from there. Also, you can see on Sabrina's spreadsheet on 1/23 that she is capable of dropping down during a cycle, then bouncing back high again before the next shot time. The same certainly could have happened on 1/28 or 1/29, and now that bounce is clearing out and letting her head for lower numbers.

My thought on dose right now is that most likely Sabrina is going to need a bit more insulin to get her into green numbers and help get rid of the highs. Our protocol would call for a dose increase to 1.25 units BID because she has had nadirs in blue. If you're able to get another test at +5 or +6 tonight to see if she hits green, that would be helpful. She'll probably still need the increase, but once they start getting more green then you might want to wait a bit to see if that settles in.

eta: I see that while I was typing my long response, Carl and Sienne already posted!
 
Morning Everyone! Unfortunatley we lost power last night so I didn't see the posts til this morning.....AMPS 481 @ 6:30 tis morning I have to go out & will be back hopefully around noon today & willtest her then. Hopefully the vet tech will also call me....will let her know Sabrina's readings from yesterday. I'll keep everyone updated! Have a great day & thank you again Cindy & Sabrina cat_pet_icon
 
Dear Ms. Gross, Dr. Alex is not able to make recommendations to you based on the information you provide. This tracking is acceptable after the pet has been regulated with the proof of that regulation obtained by traditional glucose curves performed on a machine that is calibrated specifically for animals. A physical exam is also necessary to determine weight, skin condition, muscle mass and other criteria to determine whether we are reaching a therapeutic level. We have not done one curve professionally since Sabrina began insulin. Please make an appointment and then Dr. Alex will be better able to help you manage Sabrina's diabetes. ****Note to forum members*****This is what I received from my vet's office this afternoon :-x No phone calls......just this stupid email!!~! I guess they just want money, so now I have to find out how much their "official" curve + bloodwork(probably :!: )+ urinalysis +office visit. Back when Sabrina was diagnosed the vet tech said I could do the curve @ home & submit info........As it is I'm on wc right now & it took me months just to get all the supplies I needed....This SUCKS angry(2)_cat Sorry, but I just had to vent & I'll call the vet tomorrow morning....in the meantime I'll do as you suggest & see if in fact she's coming off the bounce & try to get +2 +4 & +6 before bed tonight. Any thoughts appreciated Cindy & Sabrina cat_pet_icon
 
PLEASE SEE MY PREVIOUS POST 1/30/13

angry(2)_cat Please review the email from my vet on my previous post about
sabrina's numbers....................ANY suggestions would be greatly appreciated Thanks, Cindy & Sabrina cat_pet_icon
 
This tracking is acceptable after the pet has been regulated with the proof of that regulation obtained by traditional glucose curves performed on a machine that is calibrated specifically for animals.
Click to expand...

Sounds like b.s. to me. To put it bluntly. The super duper machine calibrated specifically for animals isn't necessary. If it was, there'd be thousands of cats that would never have gone off the juice with only home testing. What it sounds like they are saying is "It's our way or the highway, and we can't be responsible for any of what you are doing with your cat. He's not fixed until we say he's fixed". Are your numbers not valid because they don't believe them? Or do they think home testing is only "useful" after the cat has reached regulation?

A physical exam is also necessary to determine weight, skin condition, muscle mass and other criteria to determine whether we are reaching a therapeutic level.
Click to expand...

I'm not quite sure what "whether we are reaching a therapeutic level" means exactly. Is that a fancy way of saying "we need to see if it's working"?

What exactly did you ask them?

I would definitely not consider paying them to do a curve. I'd say "look, here are her numbers. What do you think?" If they refuse to give you any answers, I'd say "Thanks. Can I please get a copy of Sabrina's records in case my new vet needs to get in touch with you?".

CArl
 
agree with Carl. bunch of BS. can someone post the links that can be printed to hand to vet.
I would print them off and take them in (no cat) and say I would appreciate if you read these then we can work together as a team if not, then please give me copies of my cats file for my new vet
 
Good Morning Carl ! thanks for everyones help, might need to find a new vet if I can't convert her :-x I called the office this past Tuesday evening & told them I performed Sabrina's curve & was sending her spreadsheet to them for eval. They told me Dr Alex would eval on Wed & call me back. Wednesday evening I heard no word from her, called the office & they said a vet tech would call me back on thursday. They only thing I said to them otherwise was I wasn't able to test her for ketones & they said they'd be able to do that in the office. Yesterday morning I then phoned them & gave them Sabrina's #'s from Wednesday for more comparison, was again told someone would get back to me, probably dr alex......So of course when I checked my emails, that little note was in my file! :YMSIGH: On the other front, Sabrina seems to be recovering from the bounce! Yesterday AMPS 481 +8 347(I was out @ got hm @ 3:00 to test) PMPS 320 +3 267(9:00) I just couldn't stay up to get more readings.....horrible headache!!! Probably from all the crap from the vet. This morning her AMPS 256 (6:00am) I'll test @ +2, +4.....go for physical therapy & test again when I get home......hypo is at what #? under 60? I printed out Convert A Vet & am ready to argue if need be.....the office is sending me a quote on what they would want to do & how much. On the vets behalf, they haven't seen her since Dx 9/20/12, but I only was able to start her on Lantus 3 weeks ago. I would agree to physical exam & ketone testing, but as far as the bullshit curve I'll refuse. Thanks to everyone on the forum for continuing to educate me on diabetes management. I'll post later what my plan of attack will be regarding Sabrina's care. Can anyone recommend a qualified vet in "Tri-States" of NY, NJ, & Pa(northeastern) where our 3 states meet in NE corner? Have a wonderful day! Cindy & Sabrina cat_pet_icon
 
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