Trinity 10/3 AMPS 35, +.5/52, +4/115 +6/91, PMPS 58, +.5/71

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JoeyB

JoeyB

Member Since 2013
It's been a wild ride lately with a Lantus pen going bad, and now these almost normal numbers finally showing up!

I've been mostly following TR since about the middle of August. And now having gotten over the hump of the bad pen, and back to some good insulin, Trinity's numbers are finally dropping to normal, and occasionally lower as well. (Hypo kit setup and put aside!)

It was suggested to me at this point in time by another user that I post here in TR, and ask Sienne to take a look at Trinity's SS which is linked in my sig.

If at all possible, I'm working really hard to get Trinity OTJ. She and my other civie Nubi have been completely transferred to wet food only since this has started back in June. It took some time and patience, but they eventually figured out if they didn't eat what I put down, they weren't getting anything else with my civie being the harder of the two to convince!

The spread sheet I've amassed the last 6 weeks should explain most of what's been going on with Trinity.

There was the issue during the period of approx 9/24-9/28 when the Lantus pen I was using probably went bad from somehow sucking air up into it when I was withdrawing the insulin on 9/22-23?

It took a couple days after getting the new pen to see much difference, but once the numbers started dropping, boy did they drop! She has never shown any clinical signs of any problems when her numbers have dropped as low as they did, but she seems to be happiest and most energetic when they are high double digits and 100's.

With the continuing drop of her nadirs over the last few days to such low figures, I've reduced her dose twice. From 1.5 to 1.25 to 1.

I feel good with the way things are going for Trinity, but would love to get her OTJ eventually. Aside from food, testing, insulin dosing, etc, what would be my next course of action to help her continue along this path?

In advance, thanks much to everyone who helps me along this new side path!!! I'm hoping for the best, but know in the end, there is the chance she'll always need insulin. That's ok too, as long as she is healthy and happy, which she has been very much as of late!
 
Re: AMPS 35, +.5/52, +4/115 +6/91 +9/57, PMPS 58, +.5/71

Hi Joey and welcome to Lantus Land. It looks like Trinity is still giving you a wild ride these days. I completely agree with your decision to drop her down to 1.0U today. Anytime you see a number in the 30's, she's screaming for a reduction.

Did you have any specific questions about your spreadsheet you wanted answered? Sienne is on central time, and probably won't be back on board until tomorrow.

I think you are doing a great job with the food, regular testing and even shooting low. I'm not sure how much more you can do at this point, other than making sure you have enough test strips and high carb food on hand for the next time you need them. Because I think there will be a next time. But it's really up to Trinity now. We call FD a dance here, and the cat is the one leading with us just following along.
 
Re: AMPS 35, +.5/52, +4/115 +6/91 +9/57, PMPS 58, +.5/71

hi joey! welcome from me too! i have a special spot in my heart for little tux kitters!

Here's the link on what to do if you're faced with a low number and don't know what to do: Shooting and Handling Low Numbers You can always post here and ask for suggestions for options too. Usually you can get an answer fairly quickly.

i'm back on the board after being gone a while, so forgive me if i'm telling you stuff you already know. but just in case you don't know, i want to mention that because Lantus is a depot insulin it can have a residual effect even 6 cycles after a reduction in dose. sometimes when reductions are made close together they don't hold once the depot (or shed) has drained and readjusted to the new dose. i do think it was smart that you've reduced because you're obviously seeing a lot of response right now.

not sure what happened to your insulin to make it go bad, but if you haven't seen it yet, there is a video on how to draw insulin in a way that keeps it from getting contaminated. It's found at the top of the Lantus TR page under the yellow starred sticky on taking care of your insulin. http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=151

all that said, you're obviously doing a great job. I just want to make sure you get that info because there is a ton to learn with handling FD and a person can't absorb it all at once. i know i had to hear things explained multiple times.

great job getting lots of data in to help you make decisions.

i agree with wendy - you're clearly doing all you can. the point of tight regulation is to try to keep a cat in mostly normal blood glucose numbers as much as possible, which is under 120. you're doing that. beyond that, waiting for her pancreas to heal is about all that you can do.

if we can help, just ask!
 
Re: AMPS 35, +.5/52, +4/115 +6/91 +9/57, PMPS 58, +.5/71

Definitely in the right place to see this through with expert guidance. :thumbup

Hey I can vouch for Sienne, she knows her dosing. ;-)

Perfect job with the testing. I noticed Trinity is having a classic flat yellow bounce.

There might some excitement when such a bounce clears, so watch for a possibly active cycle.
 
Re: AMPS 35, +.5/52, +4/115 +6/91 +9/57, PMPS 58, +.5/71

Thanks for the vote of confidence!! I think Wendy has been keeping an eye out as has Marje (who won't be around for another day or so).

You've been doing a great job with testing and it's great to hear that all the kitties have transitioned to canned, LC food.

There's one observation I want to immediately make. I shoot low numbers as does Marje. I won't give a shot if Gabby's numbers are in the 40s or below. Frankly, it scares the poop out of me that you shot a 35. With numbers that low, there is no margin for safety. In a situation like that, give a small amount of food and re-test in 20 min. If LC doesn't bring the numbers up, give some HC and repeat the pattern. Alternatively, if your schedule can't accommodate stalling, then skip the shot.

I want to make sure that you are familiar with the TR protocol -- at least the modification we use here:
Reducing the dose:
  • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
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The reason I bring this up is that it looks like you've missed a few dose reductions (e.g., 9/17, 9/19, 9/10). My hunch is that you're seeing these numbers in the 30s because the depot is a bit too full and driving the numbers down.

The TR Protocol, by it's very nature, is aggressive. You don't want to be overly aggressive, though. Given the two most recent reductions, I'm hoping that you've gotten the insulin depot to level off.

The other thing I would emphatically encourage is that when you get low numbers, you need to consider testing more often. If you look at Gabby's SS, you'll see that I test every 30 min. when I see that her numbers are getting into dose reduction range and when I'm feeding is noted in the comments section of the SS. IMHO, the only way to keep a kitty safe is for you to be controlling the numbers by testing and feeding. I don't know if anyone over on the Relaxed board directed you to this post on How to Handle Low Numbers. The members here stick pretty close to the procedure outlined in the link.

Please let us know if you have specific questions. We're all here to help.
 
Re: AMPS 35, +.5/52, +4/115 +6/91 +9/57, PMPS 58, +.5/71

It looks to me in the Remarks section of the spreadsheet that you actually shot AMPS of 52 at +12.5 and PMPS of 71. Is that correct?
I was going to say something earlier, but didn't want to confuse or overwhelm you. If you had a 35 at +12, and then shot the insulin at +12.5 when he was 52, then you really should put both the 35 and the 52 in the AMPS column of the spreadsheet (you can stack both numbers in the same column and separate them with a comma, you just have to manually add the green color) and you could then put the 58 in the +11 column if it was actually only 11 and 1/2 hours after you shot the morning insulin and put the 71 in the PMPS column. Sorry, if that's too much information.

I see another 34 today on your spreadsheet. I would lower the dose to 0.75 starting tonight.

Edited to add: Normally, we don't recommend back to back reductions, or reductions taken too soon as you did just reduce the dose a day and a half ago, and the depot from the previous higher dose of 1.25 could still be having an affect on the cycles until the depot drains a little to the new dose of 1.00, but I think that 34 is saying something.

Let's see if anyone else chimes in.

And, I agree with Sienne. Unless my cat is surfing along for a while in the 50s, whenever I get any number below 60, I start testing every half hour. We also have a saying of Feed The Forties no matter where in the cycle. Did you feed that 34? I hope so.

Please let us know if I confused you, or if you have any questions or need clarification.
 
Re: AMPS 35, +.5/52, +4/115 +6/91 +9/57, PMPS 58, +.5/71

Holy cow. You've had a few exciting days in a row. ;-)

I think I agree with Dyana on the reduction to .75u tonight. It looks like the depot is still ahead of the dose. And she's right, usually back to back reductions aren't advised. But this kitty looks bound and determined to slide down the dose ladder at an frantic pace.
 
Re: AMPS 35, +.5/52, +4/115 +6/91 +9/57, PMPS 58, +.5/71

I'm glad Dyana caught the numbers in the comments section of your SS. I missed it. FWIW, the pre-shot number is the number you actually shoot. It's not the number that you get at your +12 if you are stalling or your shot is delayed for some reason. So, if you shoot an hour later than your usual time, that number is your pre-shot test number.

Today, your AMPS would be the test number at +12.5. It also means that your PM shot is due 12 hours after your AM shot time. You can move the shot time backwards in increments of 15 min. at each shot or 30 min. once a day.
 
Re: AMPS 35, +.5/52, +4/115 +6/91 +9/57, PMPS 58, +.5/71

Sienne and Gabby said:
I'm glad Dyana caught the numbers in the comments section of your SS. I missed it. FWIW, the pre-shot number is the number you actually shoot. It's not the number that you get at your +12 if you are stalling or your shot is delayed for some reason. So, if you shoot an hour later than your usual time, that number is your pre-shot test number.

Today, your AMPS would be the test number at +12.5. It also means that your PM shot is due 12 hours after your AM shot time. You can move the shot time backwards in increments of 15 min. at each shot or 30 min. once a day.
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Wow! Lots of good info here and above! I'll try to cover one thing at a time that you brought up.

I work mostly nights, so am usually not around until after 10-11pm EST, but do have a chance to be here 10am or so, and around 2-4pm sometimes too. This is part of the reason for my 10am/10pm shot times to fit in with my occasional day work as well.

I have gotten my spread sheet adjusted now with the info you gave me regarding actual tests and PS postings. All my earlier test results were removed from AM/PMPS and the actual PS results were put in their place. I left the comments alone since they explain the situation leading up the actual PS #'s and times.

Tonights PMPS was another example of great numbers! My AM+9 test was a 34 and the usual PMPS at 10pm was 43, so I held the shot and at 10:30 it was 56 so I went ahead with a reduction to a .75u as mentioned in prior comments by Carl and Dyana which I agreed with.

Just to fill in all the little details that the SS doesn't cover, here is a quick summary of how Trinity has been clinically through the last few days great numbers.

She has been almost ravenous! Eating probably 150% of what she actually needs according to what I've read. There has been a somewhat marked increase in her appetite since around the time that I started the new Lantus pen. I don't skimp on her food since it's mostly LC and I know she may not be absorbing all the nutrients she can in a perfectly healthy condition.

She has also almost never shown any ill effects from the low test results that I've posted the last few days. The one exception to this was the morning of 10/3 when she initially tested at 35. That morning, she was a bit over-tired and showed very little energy to eat at first unlike most morning feedings, but when I returned from work about 40 mins later and retested her at 52, she was pretty much acting normally.

Thanks to everyone for your advice! It helps me know I am going in the right direction with Trinity. I have read so much lately about this subject, it seems like I've forgotten half of what I've read but it's remembered quickly when someone else points it out to me again!

Here's hoping for a quick trip to OTJ for Trinity if things continue along the direction they now seem to be taking!
 
Re: AMPS 35, +.5/52, +4/115 +6/91 +9/57, PMPS 58, +.5/71

If she was acting tired and lethargic and not wanting to eat when you tested that 35 at AMPS the other day, she could have been lower than that an hour or hours before.

Cats are often really sensitive to insulin when they have a symtomatic sp? hypo. I would try to get more tests when you can. And please, if you get tests under 50, feed to get her up out of the 40s, or below, and test every half hour.

You're doing a good job with Trinity. I wish you the best.
 
Re: AMPS 35, +.5/52, +4/115 +6/91 +9/57, PMPS 58, +.5/71

Welcome to Lantus Land! Nice job! The others above my post to your condo have given you a wealth of information to work with. Hoping you both have a wonderful day!
 
Re: AMPS 35, +.5/52, +4/115 +6/91 +9/57, PMPS 58, +.5/71

Good job fixing the SS. Since you have the +12 readings (35, 43) for those cycles you can put those in the corresponding +11, so you can always see what the trend was (at a glance) leading up to those shots.

As for the current skipped shot, could still be the depot talking? I'll defer to Dyana, Sienne, and Co. for what tonight's dose should be. :smile:
 
Re: AMPS 35, +.5/52, +4/115 +6/91 +9/57, PMPS 58, +.5/71

Hello Joey, I see Trinity was keeping you busy again this morning. BTW, we normally start a new posting each day for the cat, so we can see what the latest numbers/status is. You don't need a new posting every day, but when you have questions we like to see a new one. I think you did the right thing this morning to skip since you couldn't monitor.

With that 39 you got this morning, you might be thinking another decrease, but we think that you should hold that .75U dose for tonight. The reason is that it's probably the Lantus depot from previous higher doses that is still influencing Trinity's numbers. The depot can affect up to 6 cycles and back then Trinity was still getting 1.25U.

There's one other thing I'd like to bring up, to help keep Trinity safe. We suggest to caregivers, that if they get low numbers, under 50, they feed and retest every 30 minutes. Here is the posting on Shooting and Handling Low Numbers. What's really important is that you see two rising non food influenced numbers before you stop testing and either leave for the day or go to sleep. The effects of food or karo/syrup can wear off and the numbers can go down again. It's dangerous for cats to spend any length of time in the 30's so we feed and test to make sure the cat is over 50 and staying up. If you have to leave for work, then make sure you leave a bunch of high carb food out for Trinity to munch on if she needs it. Last night you had a preshot of 56 but didn't test again until +5. If you had to leave, I hope you left food out. Any preshot in the 50's means more frequent testing.
 
Re: AMPS 35, +.5/52, +4/115 +6/91 +9/57, PMPS 58, +.5/71

Wendy&Neko said:
Last night you had a preshot of 56 but didn't test again until +5. If you had to leave, I hope you left food out. Any preshot in the 50's means more frequent testing.
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The actual PMPS was 43 and I held the shot until a test at +.5 which was 56. Half hour later not +5. ;-)

I've had to adjust some of my postings due to holding shots due to low numbers. I've updated my SS to reflect actual PS readings according to others suggestions here to keep things easier to read. Most of these situations have comments explaining them.
 
Re: Trinity 10/3 AMPS 35, +.5/52, +4/115 +6/91, PMPS 58, +.5

Joey, I was referring to your next test at +5 of 101. If you see a 43, then half an hour later a 56, it's a good idea to test 1/2 hour later to make sure she isn't headed back down again. Without testing, you don't know if she went low again between PMPS and +5.
 
Re: AMPS 35, +.5/52, +4/115 +6/91 +9/57, PMPS 58, +.5/71

JoeyB said:
...The actual PMPS was 43 and I held the shot until a test at +.5 which was 56. Half hour later not +5. ;-)

I've had to adjust some of my postings due to holding shots due to low numbers. I've updated my SS to reflect actual PS readings according to others suggestions here to keep things easier to read. Most of these situations have comments explaining them.
Click to expand...
Ah so that was 4.5 hours not 5. I saw the wink. ;-)

Actually if I was home/awake during that time I'd want at least the +2, it can be a great predictor of the cycle. In that particular instance +1.

BTW if any of these conventions or recommendations are unclear (or more than you think you can handle) feel free to discuss it here. There may be some workarounds.

Looks like you are doing an awful lot right already, so it's really about having plenty of experienced eyes watching so you can stay on track. :-D
 
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