Stalling again ... in the mid 200s/low teens from +6.5 to +13.25 and counting ...

A

Alana & Fatty

Member Since 2020
Fats is a wild child! I was considering trying an experimental dose reduction down to 1.0 anyways because for the past several days, he's had big drops (50% from PS to nadir) for one cycle, then higher and flatter for the next, then repeat -- exact same pattern. Seems like a mild bounce?

But now his PS is low (for him) and I guess we will wait and see. Stalled for 1.25hr so far, no food, and his BG hasn't gone up (it has gone down a smidge but basically stayed the same). You would not believe the "gimme dinner" look I'm getting :cat:
 
You have shot on low yellows before.
With SLGS, rule of thumb is to shoot if the BG is >200 and you don't have much test data.

But you have plenty of test data. You test plenty. You know how to monitor. You know what hypo symptoms to look for.
Sir Fats has not dropped into the those green BG levels in a long time, several weeks.
So why don't you go ahead, give him dinner and give him the insulin?

Fatty would be happy, and stop giving you the stink eye for delaying his din-din.
As long as you have enough test strips, can monitor and have your hypo toolkit well stocked with MC and HC food, you should be good to go.
 
Thank you for the confidence boost. I went with 0.5 -- was planning on trying him out at 1.0 tonight before we got these lower numbers, but I based the 0.5 on his dose from mid Jan (the last time he was on this lower carb food and had a similar PS number). The yellows I have since shot on were when he was eating the higher carb food so I went with a conservative dose ... fingers crossed it suits him okay tonight, then I'll probably try 1.0 tomorrow morning.

He looks much happier now with a full tummy, which is the goal! :)
 
Sir Fats stayed in the yellows most of the night but crept up into pinks and had a low red AMPS. I took him right back to 1.2U. His urine ketones were neg at +8.5 last night and blood ketones were at 0.5mmol/L at AMPS (I keep referring back to that chart that has anything under 0.6mmol/L as normal blood ketones to make myself breathe) but he ate well this morning (extra water added to his breakfast), had insulin, and I am about to give him subqs, and will monitor blood ketones aggressively/obsessively ...

I think I will hold off on the experimental dose reduction. I was considering that based on him going blue one cycle, then higher and flatter the next, rinse and repeat -- thought maybe the flatter cycles were gentle bounces. But the high/flat cycles are becoming lower, so maybe he just needs a few more days to level off a bit?
 
Not sure what you mean by 0.1 mmol/L, since your SS says 24.3 mmol/L.
Would you please explain? Might just be my feeble old brain, not understanding you.

I agree with you that the experimental dose reduction is not needed right now.
He still has a long way to drop, down into the green BG ranges before he's ready for a dose reduction.

Alana & Fatty said:
He looks much happier now with a full tummy, which is the goal!
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I bet he WAS super happy. Happy IS the goal, and feeling better too.
 
Deb & Wink said:
Might just be my feeble old brain, not understanding you.
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Oh that's not your brain's fault, it's mine -- blood ketones were down to 0.1 mmol/L, so I was (am!) happy about that.

Deb & Wink said:
I agree with you that the experimental dose reduction is not needed right now.
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I was basing this not so much on the nadirs, but on my (possibly completely incorrect) thought that his every-other-cycle habit of staying higher and flatter after a more active dip into the blues is a little bounce. Does that make sense at all? Before his high/flat bounce cycles were much higher, but I'm trying to figure out why, without fail, he has a nice smile-shaped cycle, then a higher/flatter, over and over again.
 
It might look a little off on my SS because I skipped half a row of cells to adapt to his new dosing schedule, but for the 5 days before yesterday (when I cut his dose by too much), he would go into the blues in the day then higher/flatter during the night (unless I missed those dips, but I think/hope I would have caught some indication of PM dips) ...
 
Blood ketones! Of course. :banghead: Now I understand. That's what I get for not reading all the Remarks on Fatty's SS.
That low blood ketone reading was very nice to see.

Alana & Fatty said:
he would go into the blues in the day then higher/flatter during the night (unless I missed those dips, but I think/hope I would have caught some indication of PM dips)
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I think you would have caught it too, if Fatty had dipped low in the PM.

I'm thinking you are going to need to bump the insulin dose up again soon.
 
Deb & Wink said:
That's what I get for not reading all the Remarks on Fatty's SS.
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But really, who has time to read all those? I write so much stuff in there ... :rolleyes:

Deb & Wink said:
I'm thinking you are going to need to bump the insulin dose up again soon.
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The last few cycles have had higher nadirs (can we call them that if the cycles are basically flat?), but I hesitate to increase the dose with these low PS numbers. Last night's PS was 272 or 15.1, and this morning's PS was 247 or 13.7. But I'm not seeing him drop really over the last 4 cycles, though he dipped into the high blues this cycle. Before I was seeing higher PS numbers and lower nadirs, and the past 4 cycles I'm seeing flat low yellows ... do you think that still warrants a dose increase? I feel like maybe he is preparing for an active cycle after these flatties, but what do I know! I just know the thought of increasing his dose with a noticeable lower PS freaks me right out. Does diabetes ever get less confusing?
 
Those PS you are getting in the high yellows, aren't that low.
It's only pre-shots <200 WITHOUT much test data that might be considered low.

Those blues at mid-cycle you are getting. Those aren't really that low.
<50 mg/dL (<2.7 mmol/L) would be low.
<90 mg/dL (<5 mmol/L) would be low enough to earn Fatty a dose reduction.

He's no where near that, earning a dose reduction.
You want to see him in the blue and tree green BG levels as much as possible.

You need to take a leap of faith, and increase Fatty's dose. Those BG's in the pink and red ranges, and even the yellows, aren't making him feel good.
BUT, think about increasing the dose on an AM cycle, when you are more awake to monitor.
Alana & Fatty said:
Does diabetes ever get less confusing?
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Not usually.
 
This post has me laughing. I am going to print this out and stick it to my fridge and read it whenever I am hesitating about increasing his dose (so, every day).

Deb, thank you for explaining this so clearly (again and again) ... Sir Fats is at 1.2U this morning and I will increase when I can monitor (vet appointment today over his nadir).
 
Hesitating to increase the dose is perfectly normal.
So if you hesitate every day, then you are simply thinking things through, and trying to do your best for Sir Fats.

I can see that Fats did not like his visit to the vet. Thinking those high BG's, especially the red at +8 was due to some vet stress.


p.s. I've only had 1 cat in my life that LIKED going to the vet. She was a real weirdo, but loved being there in the exam room, and looking out the window at everything going on. All my other cats either sat there like scared little lumps afraid to even move, or hid under a chair, or jumped up on a counter to try and escape.
 
Deb & Wink said:
Hesitating to increase the dose is perfectly normal.
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It completely baffles me how when Fats was first diagnosed, and the vet said to check his BG ONCE A WEEK AT NADIR, I thought that was fine. What in the ... freaking ... fluff ... I guess now I have swung the other way and am a nervous wreck. Thank you for guiding me through this process -- I really do appreciate you and the time you spend coaching me.

Deb & Wink said:
Thinking those high BG's, especially the red at +8 was due to some vet stress.
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Fats definitely did not like his vet visit ... we went last Friday as well and went red then too (and black after the previous week's visit -- praying and hoping and wishing that doesn't happen tonight). But! He just got his 3rd ESA shot for anemia and he is officially *not* anemic! This shot will hopefully give him a bit of a buffer too and help him have lots of strength and energy for stair soccer.

Deb & Wink said:
p.s. I've only had 1 cat in my life that LIKED going to the vet.
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Although he doesn't like being at the vet, he often likes getting there and back. Today we took an Uber but sometimes my dad (who calls Fats his grandkitty) drives us, and Fats loves to roam around the truck and look out the windows with his paws on the top of the door like a little doggie. Sounds like your weirdo vet-loving kitty has a kindred spirit :cat::cat:
 
Sir Fats is looking better today, with some nice blues at mid-cycle and nadir.

Alana & Fatty said:
But! He just got his 3rd ESA shot for anemia and he is officially *not* anemic!
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Fantastic news!

Alana & Fatty said:
Although he doesn't like being at the vet, he often likes getting there and back.
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Look on the bright side! That is certainly better than having a cat that pees, poops, and vomits in the cat carrier on the ride to the vet.
 
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